Long-term complications of laparoscopic Roux-en-y gastric bypass: Strategies for prevention, diagnosis, and management

Background:Laparoscopic RYGB simultaneously causes food malabsorption  and restricts food intake and generally results in more weight loss than restrictive operations, including the Lap-Band gastroplasty. Patients who have laparoscopic RYGB generally lose about two-thirds of their excess weight in 2 years and within 3 years they lose 68-72% of excess weight. At ten years, most patients continue to keep off at least 50% of the excess weight.Long-term complications include pouch stretching,  and gastrojejunal anastomotic strictures. Because  gastric bypass operations  cause food to skip the duodenum, risks for nutritional deficiencies  are higher than for restrictive procedures. Anemia may result from malabsorption  of vitamin B12 and iron in menstruating women, and decreased absorption of calcium may bring on osteoporosis and bone disease. Long-term  complications may also include deficiencies  in vitamins A, D, E, Bl, B6, and folic acid. Patients must take nutritional  supplements daily to manage these side effects. Patients and methods: The study consisted of 40 patients operated upon from January 2005 to September 2009 with minimal follow up of 6 months. Patients, who are operated before May 2008, were 20 patients and they were studied retrospectively. Prospective study was conducted on 20 patients who were operated on from May 2008. Results:  Nineteen patients  (57.5%)  developed late complications (>30 days). One patient developed  myocardial ischemia  (2.5%)which was treated  by stent and resolved,  3 patients developed prolonged nausea (7.5%) which resolved spontaneously, 2 patients (5%) developed repeated  vomiting  which  resolved  spontaneously, 2 patients   developed  gastrojejunostomy anastomotic stricture  (5%) which resolved  after endoscopic balloon dilatation, one patient (2.5%) developed symptomatic gall stones and was treated by laparoscopic cholecystectomy, one patient developed  marginal ulcer(2.5%)  and was treated by proton pump inhibitors  and resolved. One patient  developed  depression and he was normal preoperatively, however he received medications and improved. One patient developed incisional hernia (2.5%) at trocar site which was repaired. Six patients (15%) developed iron deficiency anemia and were treated by iron. One patient (2.5%) developed protein-calorie malnutrition and improved with TPN and dietary counseling. Conclusions: The important outcome related to the goal ofbariatric surgery such as weight loss, important reduction in comorbidities and good quality of life results in this study appear acceptable if compared with other series.