Background Long-term evaluations 10 years after Roux-en-Y gastric bypass (RYGB) are limited. We report the development in weight and cardiovascular risk factors during 10 years after laparoscopic RYGB, with evaluation of gastrointestinal symptoms and quality of life (QoL) at 10-year follow-up. Methods We performed a prospective longitudinal cohort study. Patients operated with laparoscopic RYGB from May 2004 to November 2006 were invited to 10-year follow-up consultations. Gastrointestinal Symptom Rating Scale (GSRS) questionnaire and two QoL questionnaires were used for analyses of gastrointestinal symptoms and QoL. Results A total of 203 patients were operated; nine (4.4%) died during follow-up. Of 194 eligible patients, 124 (63.9%) attended 10-year follow-up consultations. Percent excess weight loss (%EWL) and percent total weight loss (%TWL) at 10 years were 53.0% and 24.1%, respectively. %EWL > 50% was seen in 53.2%. Significant weight regain (≥15%) from 2 to 10 years was seen in 63.3%. Remission rates of type 2 diabetes, dyslipidemia, and hypertension were 56.8%, 46.0%, and 41.4%, respectively. Abdominal operations beyond 30 days after RYGB were reported in 33.9%. Internal hernia and ileus (13.7%) and gallstone-related disease (9.7%) were the most common causes. Vitamin D deficiency (<50nmol/L) was seen in 33.3%. At 10 years, bothersome abdominal pain and indigestion symptoms (GSRS scores ≥3) were reported in 42.9% and 54.0%, respectively, and were associated with low QoL. Conclusion We observed significant weight loss and remission of comorbidities 10 years after RYGB. Significant weight regain occurred in a substantial subset of patients. Gastrointestinal symptoms were common and negatively impacted QoL. Keywords Long-term outcomes • Gastric bypass • Weight loss • Cardiovascular risk factors • Gastrointestinal symptoms Roux-en-Y gastric bypass (RYGB) surgery is commonly applied for the treatment of morbid obesity. Short-term and medium-term outcomes are well documented and include health benefits such as significant weight loss, improvement in obesity-related comorbidities and improved quality of life (QoL) [1-5]. A limited number of studies reports on outcomes 10 years and beyond after RYGB [6-18]. Available studies indicate sustained weight loss and high remission rates of diabetes, hypertension, and dyslipidemia after RYGB. The follow-up rates, however, are often low. Long-term evaluations on gastrointestinal symptoms after RYGB are limited. We have previously observed high rates of such symptoms 2 and 5 years after RYGB [19, 20]. Long-term evaluations and knowledge of such symptoms may improve the quality of health care for these patients. Pending results from national and multinational databases will enlighten long-term outcomes after bariatric surgery. However, prospective cohort studies may supplement larger register-based studies, with in-depth individual evaluations. A single-center cohort study aiming to report weight development and remission of metabolic comorbidities, gastrointestinal symptom...

Background The optimal surgical weight loss procedure for patients with a BMI of 50 kg/m 2 or more is uncertain. This study compared distal Roux-en-Y gastric bypass (RYGB) with standard RYGB. Methods In this double-blind RCT, patients aged 18–60 years with a BMI of 50–60 kg/m 2 were allocated randomly to receive standard (150 cm alimentary, 50 cm biliopancreatic limb) or distal (150 cm common channel, 50 cm biliopancreatic limb) RYGB. The primary outcome (change in BMI at 2 years) has been reported previously. Secondary outcomes 5 years after surgery, such as weight loss, health-related quality of life, and nutritional outcomes are reported. Results Between May 2011 and April 2013, 123 patients were randomized, 113 received an intervention, and 92 attended 5-year follow-up. Mean age was 40 (95 per cent c.i. 38 to 41) years and 73 patients (65 per cent) were women; 57 underwent standard RYGB and 56 distal RYGB. BMI was reduced by 15.1 (95 per cent c.i. 13.9 to 16.2) kg/m 2 after standard and 15.7 (14.5 to 16.9) kg/m 2 after distal RYGB; the between-group difference was −0.64 (−2.3 to 1.0) kg/m 2 ( P = 0.447). Total cholesterol, low-density lipoprotein cholesterol, and haemoglobin A1c levels declined more after distal than after standard RYGB. High-density lipoprotein cholesterol levels increased more after standard RYGB. Vitamin A and vitamin D levels were lower after distal RYGB. Changes in bone mineral density, resting metabolic rate, and total energy intake were comparable. Conclusion Distal RYGB did not enable greater weight loss than standard RYGB. Differences in other outcomes favouring distal RYGB may not justify routine use of this procedure in patients with a BMI of 50–60 kg/m 2 . Registration number: NCT00821197 ( http://www.clinicaltrials.gov ). Presented in part as abstract to the IFSO (International Federation for the Surgery of Obesity and Metabolic disorders) conference, Madrid, Spain, August 2019.

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