[Therapeutic failures after gastric bypass operations for morbid obesity].

Background: Although gastric bypass is an effective treatment for morbid obesity, the postoperative results are unsatisfactory in 10% of all patients. Therapeutic failures after an operation performed with the sole purpose of reducing the risk of obesity-associated diseases have to be taken seriously. The goal of this study was to investigate the causes of these failures.

Method: From 1979 to 1993, 165 gastric bypass operations (technique: Mason-Griffen) were performed. Long-term results were obtained in 60 patients after an average of 6.6 years (range 3-13). On follow-up all patients were examined and asked about their level of satisfaction with the weight loss achieved and changes in eating habits.

Results: In 6 patients the weight reduction was regarded as insufficient (BMI > 35 and reduction of BMI < 10). The causes of these failures were technical in 3 cases (gastric pouch to 0 large in 1, dilatation of gastrojejunostomy in 2). Three patients had a high calorie intake through an intact gastric bypass by snacking. Three patients regarded the operation as a failure although they had achieved significant weight loss, because they could no longer eat the usual amounts of food.

Conclusion: Correct surgical technique and preoperative information on the changes in eating habits after a gastric bypass operation are the most important steps in preventing therapeutic failures.