Malabsorptive gastric bypass in patients with superobesity.

Weight loss in superobese patients has been problematic after conventional gastric restrictive operations including conventional Roux-en-Y gastric bypass (RYGB). The goal of the present study was to compare weight loss in patients with superobesity (body mass index > or =50 kg/m(2)) using a distal RYGB (D-RY) in which the Roux-en-Y anastomosis was performed 75 cm proximal to the ileocecal junction (N = 47) vs. patients who had Roux limbs of 150 cm (N = 152) and 50 to 75 cm (N = 99).

Are vitamin B12 and folate deficiency clinically important after roux-en-Y gastric bypass?

Although iron, vitamin B12, and folate deficiency have been well documented after gastric bypass operations performed for morbid obesity, there is surprisingly little information on either the natural course or the treatment of these deficiencies in Roux-en-Y gastric bypass (RYGB) patients. During a 10-year period, a complete blood count and serum levels of iron, total iron-binding capacity, vitamin B12, and folate were obtained in 348 patients preoperatively and postoperatively at 6-month intervals for the first 2 years, then annually thereafter. The principal objectives of this study were to determine how readily patients who developed metabolic deficiencies after Roux-en-Y gastric bypass responded to postoperative supplements of the deficient micronutrient and to learn whether the risk of developing these deficiencies decreases over time.

Prophylactic iron supplementation after Roux-en-Y gastric bypass: a prospective, double-blind, randomized study.

Objective: To determine whether prophylactic oral iron supplements (320 mg twice daily) would protect women from iron deficiency and anemia after Roux-en-Y gastric bypass.

Design: Prospective, double-blind, randomized study in which 29 patients received oral iron and 27 patients received a placebo beginning 1 month after Roux-en-Y gastric bypass.

Setting: Tertiary care medical center.

Weight loss and dietary intake after vertical banded gastroplasty and Roux-en-Y gastric bypass.

Objective: The purpose of this study was to learn whether preoperative eating habits can be used to predict outcome after vertical banded gastroplasty (VBG) and Roux-en-Y gastric bypass (RYGB). BACKGROUND SUMMARY: Several independent randomized and sequential studies have reported significantly greater weight loss after RYGB in comparison with VBG. Although the mechanism responsible for weight loss after both procedures is restriction of intake rather than malabsorption, the relationships between calorie intake, food preferences, and postoperative weight loss are not well defined.

Long-limb gastric bypass in the superobese. A prospective randomized study.

This study was designed to determine whether greater diversion of bile and pancreatic secretions away from the functional gastrointestinal tract would produce greater weight loss in superobese patients (greater than or equal to 200 pounds overweight) in comparison with conventional Roux-en-Y gastric bypass (RYGB). During the past 7 years, two modifications of RYGB were prospectively compared in 45 superobese patients: RYGB-1, in which the length of defunctionalized jejunum measured 75 cm, and RYGB-2, in which the defunctionalized jejunum measured 150 cm. Respective mean preoperative weight/body mass indexes were 393 pounds/63.

Multivitamin prophylaxis in prevention of post-gastric bypass vitamin and mineral deficiencies.

One hundred forty patients were followed for a mean 24.2 months after gastric bypass. Postop multivitamin (MV) prophylaxis was recommended for all patients and 90 of 140 patients (64 percent) were regularly compliant.

Serum lipids after gastric bypass surgery for morbid obesity.

Thirty-eight of 151 consecutive patients (25 percent) undergoing bypass surgery for morbid obesity had increased serum levels of total cholesterol (TC), triglycerides (TG) or both preoperatively. Ten patients had isolated TC elevation, six had isolated TG elevation and 22 had both TC and TG elevation. High density lipoprotein-cholesterol (HDL-C) levels were subnormal in 28 of the 38 patients (74 percent).

Changes in eating behavior after horizontal gastroplasty and Roux-en-Y gastric bypass.

Postoperative changes in eight dietary variables were compared at 6-mo intervals over 24 mo in 53 horizontal-gastroplasty (HGP) and 51 Roux-en-Y gastric-bypass (RYGB) patients; the variables included 1) calorie intake; percent intake of 2) protein, 3) carbohydrate, and 4) fat; 5) sweets and high-calorie beverages (SWS) and 6) milk and ice cream (MIC) as percent of calories; and 7) high-calorie liquids (HCL) and 8) nonliquid sweets (NLS) as percentage of dietary sugar. Weight and calorie intake were significantly less after RYGB than after HGP after 6 mo (p less than or equal to 0.01).

The dilemma of outcome assessment after operations for morbid obesity.

Outcome of 56 patients who underwent horizontal gastroplasty (HGP) and 126 who underwent Roux-en-Y gastric bypass (RYGB) was assessed at 18 months postoperatively according to three definitions of successful weight loss; also, outcome was evaluated in the context of amelioration of obesity-related medical problems. Outcome definitions included the following: I, loss of 25% or more of preoperative weight; II, loss of 50% or more of excess weight; III, loss to within 50% of ideal body weight. To evaluate the impact of preoperative weight on success rate, patients were divided into two weight groups: "morbidily" obese patients, who were 100 to 199 pounds overweight (n = 146), and "super"-obese patients who were 200 pounds or more overweight (n = 36).

Diagnosis-related group impact of nutrition support in cardiac surgery patients.

We studied the diagnosis-related groups (DRG) impact of nutrition support on 80 consecutive cardiac surgery patients operated upon during a 6-month period. Six of 80 patients were nutritionally depleted preoperatively. Seven received postoperative supplemental nutrition, all of whom had major postoperative complications.