Background

Long-term data on the likelihood of undergoing additional related procedure after laparoscopic Roux-en-Y Gastric Bypass (LRYGB) remain scarce. The aims of this study are to identify the long-term incidence of bariatric related procedures, patient's predictive factors, and most common operations in the 15-20 years following LRYGB.

Methods

We performed a retrospective analysis of all LRYGB performed at Single Institution from 2003-2008. All subsequent bariatric related procedures performed were manually reviewed. We excluded upper endoscopies. Our Institutional policy within the studied period entailed that all patients with cholelithiasis at the time of LRYGB underwent concomitant cholecystectomy, and all internal spaces were closed. Kaplan-Meier analysis was utilized to estimate the time to procedure. Cox regression was used to determine patient's factors associated with time until procedure.

Results

Of the 665 patients included, 35% had >15 years follow-up (median follow-up = 14 years). There were 248 (37.3%) with a related procedure. After excluding panniculectomy, 199 (29.9%) had a related procedure. The 3 most common procedures were panniculectomy [n=77 (12%)], followed by cholecystectomy [n=64 (10%)], and internal hernia repair [n=56 (8%)]. The Kaplan-Meier estimated incidence of related procedure at 15 years was 43.7% and 35.3% after excluding panniculectomy. Females (HR=1.77, 95% CI=[1.20, 2.62, p=0.0039), age<50 (HR=1.42, 95% CI=[1.07, 1.88], p=0.014), and BMI>60 (HR=2.77, 95% CI=[1.30, 5.91], p=0.0083) were more likely to have a related procedure.

Conclusions

Bariatric related procedures are common after LRYGB. Previous reports have likely underestimated the rate of related surgeries, particularly biliary procedures.