ObjectiveThe 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

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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/63.4 for 22 RYGB-1 patients and 404 pounds/61.6 for 23 RYGB-2 patients. Two patients (5%) had nonfatal early complications. There were six late incisional hernias. There were no cases of protein deficiency, hepatic dysfunction, or diarrhea after operation. Mean follow-up was 43 +/- 17 months. Postoperative weight loss in pounds and daily calorie intake were compared at 6-month intervals. Weight loss stabilized by 24 months at a mean 50% excess weight lost in RYGB-1 patients and 64% excess weight lost in RYGB-2 patients. Nineteen of 23 RYGB-2 patients achieved at least 50% excess weight lost versus 11 of 22 RYGB-1 patients (p less than or equal to 0.03). Weight loss was significantly greater at 24 through 36 months in RYGB-2 versus RYGB-1 patients (p less than 0.02). There was no significant difference in either calorie intake or incidence of iron and vitamin B-12 deficiency between the two groups. These data show that gastric restriction and biliopancreatic diversion without intestinal exclusion resulted in significantly greater weight loss than conventional RYGB but did not cause additional metabolic sequelae or diarrhea. This long-limb modification of Roux-en-Y gastric bypass is a safe and effective procedure in patients who are 200 pounds or more overweight.

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). Protein intake was significantly increased at all intervals after RYGB and at 6 and 12 mo after HGP (p less than 0.05). After RYGB, intakes of SWS, MIC, and HCL were significantly decreased at all intervals (p less than 0.05). SWS and MIC consumption was also significantly less after RYGB than after HGP (p less than or equal to 0.05). Decreased SWS and MIC consumption in RYGB patients suggests that food-preference differences are partially responsible for the lower calorie intake and greater weight loss after RYGB than after HGP.

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The incidence and significance of histologic vascular and/or neural invasion in 77 patients with colorectal carcinoma treated over a 6-year period were analyzed retrospectively. Vascular invasion was found in 37.6% of patients and neural invasion in 14.3%. The following three types of vascular invasion were identified: tumor lining epithelium, tumor thrombi, and destruction of the vessel wall. The incidence of metastases in patients with vascular invasion was 60% as opposed to 17% in those without vascular invasions (P less than 0.0001). Survival in these patients was 29.7% and 62.2%, respectively (P less than 0.003). Metastases were found in 72.7% of patients with neural invasion, as opposed to 27% of those without neural invasion (P less than 0.01). Survival was 29.6% as opposed to 57.7% in those without neural invasion (P less than 0.003). Even among patients in the same Dukes' stage, prognosis, as determined by incidence of recurrence, metastases, and survival, was worse significantly among those patients demonstrating vascular invasion (P less than 0.03). Examination of patients with colorectal carcinoma for the presence of vascular and neural invasion may provide useful information for determining future treatment and prognosis.

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.Patients and Interventions: Complete blood cell count and serum levels of iron, total iron binding capacity, ferritin, vitamin B 12 , and folate were determined preoperatively and at 6-month intervals postoperatively in 56 menstruating women who had Roux-en-Y gastric bypass.Main Outcome Measure: Incidence of iron deficiency and other hematological abnormalities in each treatment group.

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