Bariatric surgery : comparative analysis of the outcomes of distal gastric bypass as a primary or a revisional surgical treatment of obesity

Details

Supervisors

Pr. Benoit Navez

Faculty

Faculté de médecine et médecine dentaire

Degree label

Master [180] en médecine

Abstract

Background: Among the obesity treatments, the bariatric surgery is considered by many as the most efficacious for the long-term maintenance of weight loss and for improvement of the obesity co-morbidities. The distal gastric bypass appears like an alternative for patients requiring a more aggressive weight loss program. Objective: To evaluate the efficacy, the tolerability and the impact on co-morbidities and nutritional status of the distal gastric bypass (gastric pouch of 50 mL, alimentary limb of at least 300 cm, common limb of 100 cm, and bilio-pancreatic limb equivalent to 1/3 of the intestine total length) as a primary surgery in super-obese patients or as revisional surgery in patients having failed a previous gastroplasty or a previous classic gastric bypass. Method: 31 patients having undergone the same surgical protocol were divided in three groups: Group 1: super- obese patients (>50 BMI) without any previous gastric surgery, Group 2: patients having failed a gastroplasty, Group 3: patients having failed a classic gastric bypass. Results: The distal gastric bypass was associated with a significant weight loss in the three groups (mean EWL at 12 months = respectively 69,7, 68,2 et 57,0%, using the pre-surgery BMI as a reference). The impact on the co- morbidities as diabetes et hypertension appeared positive (some patients could stop their medication). Some peri-operative complications requested supplementary care in each group. Some long-term post-operative complications (malnutrition, diarrhea,...) occurred in each group and resulted in a proximalisation of the distal bypass distal in 2 cases (1 case in Group 1 and 1 case in Group 3). Two deaths were also reported (1 case in Group 1 and 1 case in Group 3) for which the causality with the distal bypass was not directly established (death 7 months (unknown reason) and 31 months (cardiac attack) after the surgery, respectively). Conclusions: The distal gastric bypass proposes an alternative for weight loss and resolution of co-morbidities for super-obese patients (Group 1) or patients having failed a previous bariatric surgery (Groups 2 and 3). Nevertheless some severe complications were observed. This study, due to its small population sample, needs to be completed by larger long-term studies before being possible to conclude whether the distal gastric bypass can be considered as a valuable option in super-obese patients.