title: A retrospective single-center study, evaluating the long-term effects of the roux-en-y gastric bypass on weight, metabolic health, and comorbidities
Creators: name: Hadi, Karam
Publisher: name: University of Galway
Year: 2024
Subjects: subject: Medicine
subject: roux-en-y gastric bypass
subject: weight
subject: metabolic health
subject: obesity

description: Background: The obesity health crisis has become a global health issue around the world. Obesity is a chronic disease that has exhibited detrimental effects on patients through its comorbidities that can lead to adverse cardiac events, stroke, and poor quality of life. The burden of obesity extends to governments as it is causing a rise in healthcare costs around the world and resulting in reduced productivity. This research study aimed to assess the lasting effects of Roux en-Y Gastric Bypass (RYGB) surgery, a known procedure that has been utilized for several years to assist individuals in achieving sustainable weight loss and resolution of obesity related health issues. The evaluation of the health outcomes and metabolic variables following the RYGB at different time periods in this study allowed us to find crucial insights in the management of obesity. Methods: This is a retrospective study, evaluating a cohort of patients who underwent bariatric surgery (RYGB) at Letterkenny University Hospital from 2017 to 2023. The information was gathered from the patients’ medical records including clinic notes, lab values and follow ups at baseline, and 1 to 5 years post surgery. Our research investigated variables like weight loss progressions and changes in BMI levels along with observing effects on lipid profiles and HbA1c levels post surgery. We also looked at the remission of comorbidities and post surgical complications. We conducted a range of analyses to examine shifts over time and determine their level of importance. Results: In our study, 82 participants underwent RYGB; the mean age was 46 years (SD=10.76). The cohort of patients included 58 females (70.3%) and 24 males (29.3%), with a majority of class III obese patients (N=63). Weight loss was significant from baseline in all follow-up periods. A significant decrease in the average weight was observed, 130.98Kg to 98.06Kg after one-year post-RYGB (p&lt;0.01), 96.93kg at three year (p&lt;0.01), and 95.52 kg at five-year follow-up (p&lt;0.01). Calculating the Total Weight Loss Percentage (TWL%) for after 5 years, there was a 22% TWL in comparison to the baseline weight readings. Unfortunately, there were 18% of patients who experienced ≥20% weight regain at three years post-op and 15% of patients at 5-year follow-up of the highest weight loss that the patients achieved. Focusing on the lipid profiles of patients, At one year follow up, there was a significant drop in triglyceride levels from 1.79mmol/L to 1.30mmol/L (p&lt;0.01). The mean LDL-C decreased from 2.80mmol/L to 2.29mmol/L (p&lt;0.01) while HDL demonstrated an increase from 1.22mmol/L to 1.35mmol/L (p&lt;0.01) at one-year follow-up. These reductions were consistent throughout the five years follow-up. There were significant improvements in blood sugar control, 70% of insulin-dependent diabetic patients were not insulin dependent post RYGB. From our diabetic patients who were on hypoglycemic therapy, a 75% reduction or discontinuation of hypoglycemic medications sustained over the three and five-year follow-up periods for patients. This was evident through the improvements in HbA1c levels, notably dropping for all participants from 48.6mmol/L at baseline to 40.1mmol/mol at one-year follow-up, p&lt;0.01. Although from the lowest point, HbA1c gradually increased in the follow-up periods. Comorbidities, which included hypertension, obstructive sleep apnea, and GERD, all sowed significant remission rates of up to 78.5% of hypertensives resolved by five-year follow-up. Unfortunately, in terms of mental health outcomes, there was an increase in prevalence by the end of our five-year follow-up. Postoperative complications were minimal, with the most common complication being cholelithiasis at 13.4%, followed by 4.9% of patients who experienced new addiction issues. There were no fatalities during our study periods. Conclusion: The RYGB bariatric surgery is the starting piece for transforming bariatric patients' lives. However, it is not a simple one-step solution; it is a powerful tool as an adjunct. It exhibits long-term improvements in metabolic health and the resolution of several obesity-related comorbidities. The results show sustained long-term weight loss, significant improvements in comorbidities, and improvements in general metabolic health. These positive results post-RYGB are consistent with literature from other centers. A comprehensive, evidence-based approach to the post-op period is crucial, encompassing the patients' physical and mental support. There is also a role for integrating medical therapies such as the GLP-1 receptor agonists that can be used as an adjunct to maintain weight loss and reduce weight recurrence. This study shows that environmental factors have a significant role in the post-op period, as the COVID-19 pandemic may have negatively impacted these outcomes. This study highlights the need for structured, holistic bariatric programs supporting patients, especially during clinical follow-up periods.