A RETROSPECTIVE study analysing over 15 years of follow-up data from patients who underwent Roux-en-Y gastric bypass (RYGB) provides important insights into the procedure’s long-term effectiveness and associated mortality risks.
Conducted at a Bariatric Center of Excellence (COE) in Danville, Pennsylvania, USA, this study is among the largest of its kind, offering clinicians detailed data on the outcomes of RYGB in over 2,000 patients between 2001-2008.
Of the 2,045 patients initially treated, long-term follow-up data beyond 10 years was available for 68% (1,388 patients), and more than 15 years of follow-up was achieved in 48% (987 patients). The patient population had a mean age of 46 years (range 18–72 years) and an average preoperative BMI of 47.9 kg/m² (range 35–82.2 kg/m²). Patients achieved a peak mean body weight loss of 31.8% at approximately 18 months post-surgery. Notably, weight loss remained stable, with an average sustained loss of 23% from 10 to 20 years post-operatively.
Diabetes remission was a significant outcome of RYGB. Among the 677 patients who were diabetic before surgery, 54% achieved diabetes remission by 3 years post-operation. However, remission rates declined over time, with only 38% of patients maintaining remission at the 15-year mark. Persistent diabetes after RYGB was more prevalent in patients who required insulin preoperatively (P<0.0001).
The study also highlighted notable mortality risks. The overall 15-year mortality rate following RYGB was 13.3%. However, among diabetic patients older than 60 years, mortality increased significantly to 37.4%. Analysis using Kaplan–Meier survival estimates showed that time until death was significantly shorter for older patients (P<0.001) and those with preoperative diabetes (P<0.0001).
The authors conclude that, while RYGB is effective for long-term weight loss and can offer durable diabetes remission, the benefits are moderated by higher mortality risks in older patients and those with pre-existing diabetes. Clinicians should consider these factors when discussing long-term outcomes and risks with patients considering RYGB.
Reference
Still CD et al. Long term (> 15 year) outcomes following Roux-en-Y gastric bypass. A447. American Society for Metabolic and Bariatric Surgery Annual Meeting, 9–13 June, 2024.
