Effect of vagotomy during Roux-en-Y gastric bypass surgery on weight loss outcomes.

Philip N Okafor, Chueh Lien, Sigrid Bairdain, Donald C Simonson, Florencia Halperin, Ashley H Vernon, Bradley C Linden, David B Lautz

Journal: Obesity research & clinical practice 2016;9(3):274-80

PMID: 25458372

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND

During Roux-en-Y gastric bypasses (RYGB), some surgeons elect to perform a vagotomy to reduce symptoms of gastro-oesophageal reflux (GER). Routine vagotomy during RYGB may independently affect weight loss and metabolic outcomes following bariatric surgery. We aimed to determine whether vagotomy augments percent excess weight loss in obese patients after RYGB.

METHODS

We examined the effect of vagotomy in 1278 patients undergoing RYGB at our institution from 2003 to 2009. Weight and percent excess weight loss (%EWL) were modelled at three months and annually up to five years using a longitudinal linear mixed model controlling for differences in age, gender, initial body mass index (BMI), ideal body weight, and presence of vagotomy.

RESULTS

Vagotomy was performed on 40.3% of our cohort. Vagotomy patients had significantly lower initial BMI (46.4±6.2 vs. 48.3±7.7kg/m(2), p<0.001), but there were no other significant differences at baseline. The strongest predictor of %EWL over time was initial BMI, with lower BMI patients exhibiting greater %EWL (p<0.001). Age and gender effects were also significant, with younger patients (p<0.04) and males (p<0.002) attaining greater %EWL. Vagotomy had no effect on %EWL in either simple or multiple regression models.

CONCLUSION

Our series suggest that vagotomy does not augment %EWL when performed with RYGB.

Address: Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. Electronic address: [email protected].; Department of Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, United States. Electronic address: [email protected].; Department of Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, United States. Electronic address: [email protected].; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, United States. Electronic address: [email protected].; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, United States. Electronic address: [email protected].; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, United States. Electronic address: [email protected].; Pediatric Surgical Associates, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN 55404, United States. Electronic address: [email protected].; Department of Surgery, Emerson-Mass General Hospital, Harvard Medical School, 133 Old Road to Nine Acre Corner, Concord, MA 01742, United States. Electronic address: [email protected].

DOI: 10.1016/j.orcp.2014.09.005

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MeSH Terms: Adult, Age Factors, Body Mass Index, Cohort Studies, Diet, Reducing, Electronic Health Records, Female, Gastric Bypass, Humans, Lost to Follow-Up, Male, Middle Aged, Obesity, Morbid, Recurrence, Reoperation, Retrospective Studies, Sex Characteristics, United States, Vagotomy, Proximal Gastric, Weight Loss