Gastric bypass: evolution toward mini-invasive techniques and long-term results

Joel R. Brockmeyer , Elisabeth M. Coffin

Mini-invasive Surgery ›› 2025, Vol. 9 ›› Issue (1) : 17

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Mini-invasive Surgery ›› 2025, Vol. 9 ›› Issue (1) :17 DOI: 10.20517/2574-1225.2024.86
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Gastric bypass: evolution toward mini-invasive techniques and long-term results

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Abstract

Since its inception and eventual use by Mason and Ito to treat obesity in 1966, the Roux-en-Y gastric bypass has proven to be an effective procedure for achieving durable weight loss and improving obesity-related comorbidities. Over time, the technique and its complication profile have evolved, including modifications such as lengthening the Roux and biliopancreatic limbs and altering the preferred path of the Roux limb. Due to its longstanding use, a substantial body of research has accumulated regarding the gastric bypass and its outcomes. Long-term follow-up demonstrates durable weight loss in most patients, extending up to twenty years postoperatively. Comorbidity resolution has been extensively studied, showing significant improvements in diabetes mellitus, hypertension, dyslipidemia, and other obesity-related conditions. Although the incidence of complications has decreased since the procedure’s inception, they have not been entirely eliminated.

Keywords

Gastric bypass / long-term / complications / history / outcomes

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Joel R. Brockmeyer, Elisabeth M. Coffin. Gastric bypass: evolution toward mini-invasive techniques and long-term results. Mini-invasive Surgery, 2025, 9(1): 17 DOI:10.20517/2574-1225.2024.86

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References

[1]

Mason EE.Gastric bypass in obesity.Surg Clin North Am1967;47:1345-51

[2]

Pories WJ,MacDonald KG.Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus.Ann Surg1995;222;350-2 PMCID:PMC1234815

[3]

Gastrointestinal surgery for severe obesity: National Institutes of Health Consensus Development Conference Statement.Am J Clin Nutr1992;55:615S-9

[4]

American Society for Metabolic and Bariatric Surgery. Estimate of Bariatric Surgery Numbers, 2011-2023. Available from: https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers/. [Last accessed on 26 May 2025].

[5]

Eisenberg D,Aarts E.2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): indications for metabolic and bariatric surgery.Surg Obes Relat Dis2022;18:1345-56

[6]

Gargantilla Madera P, Arroyo Pardo N. Hasday: treatment of obesity in 10th century.Endocrinol Nutr2016;63:100-1

[7]

Henrikson V.Can small bowel resection be defended as therapy for obesity?.Obes Surg1994;4:54-55

[8]

Celio AC.A history of bariatric surgery: the maturation of a medical discipline.Surg Clin North Am2016;96:655-67

[9]

Kremen AJ,Nelson CH.An experimental evaluation of the nutritional importance of proximal and distal small intestine.Ann Surg1954;140:439-48 PMCID:PMC1609770

[10]

Buchwald H.The evolution of metabolic/bariatric surgery.Obes Surg2014;24:1126-35

[11]

Friedman MN,Magovern GJ.The amelioration of diabetes mellitus following subtotal gastrectomy.Surg Gynecol Obstet1955;100:201-204

[12]

Payne JH,Commons RR.Metabolic observations in patients with jejunocolic shunts.Am J Surg1963;106:273-89

[13]

Buchwald H.Lowering of cholesterol absorption and blood levels by ileal exclusion. experimental basis and preliminary clinical report.Circulation1964;29:713-20

[14]

Buchwald H.Vitamin b12 absorption deficiency following bypass of the ileum.Am J Dig Dis1964;9:755-9

[15]

Buchwald H.Ileal bypass in patients with hypercholesterolemia and atherosclerosis. Preliminary report on therapeutic potential.JAMA1966;196:627-30

[16]

Griffen WO Jr,Stevenson CC.A prospective comparison of gastric and jejunoileal bypass procedures for morbid obesity.Ann Surg1977;186:500-9 PMCID:PMC1396298

[17]

Mason EE.Gastric bypass.Ann Surg1969;170:329-39 PMCID:PMC1387676

[18]

Alden JF.Gastric and jejunoileal bypass. A comparison in the treatment of morbid obesity.Arch Surg1977;112:799-806

[19]

Baker MT.The history and evolution of bariatric surgical procedures.Surg Clin North Am2011;91:1181-201

[20]

Casal MA.[Cesar Roux and his Roux-en-Y anastomosis].Acta Gastroenterol Latinoam1993;23:175-85. (in Spanish)

[21]

Pories WJ,Meelheim D,Thomas FT.The effectiveness of gastric bypass over gastric partition in morbid obesity: consequence of distal gastric and duodenal exclusion.Ann Surg1982;196:389-99 PMCID:PMC1352695

[22]

Alder RL, Terry BE. Measurement and standardization of the gastric pouch in gastric bypass. Surg Gynecol Obstet. 1977;144:762-3.

[23]

Torres JC,Garrison RN.Gastric bypass: Roux-en-Y gastrojejunostomy from the lesser curvature.South Med J1983;76:1217-21

[24]

Saber AA,McLeod MK.Bariatric surgery: the past, present, and future.Obes Surg2008;18:121-8

[25]

Salmon PA.Gastroplasty with distal gastric bypass: a new and more successful weight loss operation for the morbidly obese.Can J Surg1988;31:111-3

[26]

Mason EE.Vertical banded gastroplasty for obesity.Arch Surg1982;117:701-6

[27]

Scopinaro N,Civalleri D,Bachi V.Bilio-pancreatic bypass for obesity: II. Initial experience in man.Br J Surg1979;66:618-20

[28]

Fobi M.Why the operation I prefer is silastic ring vertical gastric bypass.Obes Surg1991;1:423-6

[29]

Sugerman HJ,DeMaria EJ.Conversion of proximal to distal gastric bypass for failed gastric bypass for superobesity.J Gastrointest Surg1997;1:517-24

[30]

Wittgrove AC,Tremblay LJ.Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases.Obes Surg1994;4:353-7

[31]

Wood MF,Sapala MA,Flake TM.Micropouch gastric bypass: indications for gastrostomy tube placement in the bypassed stomach.Obes Surg2000;10:413-9

[32]

Higa KD,Ho T.Laparoscopic Roux-en-Y gastric bypass for morbid obesity: technique and preliminary results of our first 400 patients.Arch Surg2000;135:1029-33

[33]

Nguyen NT,Rosenquist CJ.Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs.Ann Surg2001;234:279-89 PMCID:PMC1422019

[34]

Escalona A,Pérez G.Antecolic versus retrocolic alimentary limb in laparoscopic Roux-en-Y gastric bypass: a comparative study.Surg Obes Relat Dis2007;3:423-7

[35]

Al Harakeh AB, Kallies KJ, Borgert AJ, Kothari SN. Bowel obstruction rates in antecolic/antegastric versus retrocolic/retrogastric Roux limb gastric bypass: a meta-analysis.Surg Obes Relat Dis2016;12:194-8

[36]

Cadiere GB,Vertruyen M.The world’s first obesity surgery performed by a surgeon at a distance.Obes Surg1999;9:206-9

[37]

Talamini MA, Chapman S, Horgan S, Melvin WS; Academic Robotics Group. A prospective analysis of 211 robotic-assisted surgical procedures. Surg Endosc. 2003;17:1521-4.

[38]

Mohr CJ,Curet MJ.Totally robotic Roux-en-Y gastric bypass.Arch Surg2005;140:779-86

[39]

Read MD,Janjua H,Kuo PC.The downtrending cost of robotic bariatric surgery: a cost analysis of 47,788 bariatric patients.J Robot Surg2024;18:63

[40]

Senatore AM,Mion FU,Garofalo F.Costs of robotic and laparoscopic bariatric surgery: a retrospective propensity score-matched analysis.Obes Surg2024;34:3694-702

[41]

Bertoni MV,Garofalo F.Robotic-assisted versus laparoscopic revisional bariatric surgery: a systematic review and meta-analysis on perioperative outcomes.Obes Surg2021;31:5022-33

[42]

Coker A,Tatum J.Do advances in technology translate to improved outcomes? Comparing robotic bariatric surgery outcomes over two-time intervals utilizing the MBSAQIP database.Surg Endosc2023;37:7970-9

[43]

Aleassa EM, Papasavas P, Augustin T, et al; Clinical Issues Committee of the American Society for Metabolic and Bariatric Surgery. American society for metabolic and bariatric surgery literature review on the effect of Roux-en-Y gastric bypass limb lengths on outcomes. Surg Obes Relat Dis. 2023;19:755-62.

[44]

Obeid NR,Concors SJ,Kurian MS.Long-term outcomes after Roux-en-Y gastric bypass: 10- to 13-year data.Surg Obes Relat Dis2016;12:11-20

[45]

Kothari SN,Kallies KJ,Grover BT.Long-term (>10-year) outcomes after laparoscopic Roux-en-Y gastric bypass.Surg Obes Relat Dis2017;13:972-8

[46]

McClelland PH,Kabata K,Gorecki P.Long-term outcomes following laparoscopic Roux-en-Y gastric bypass: weight loss and resolution of comorbidities at 15 years and beyond.Surg Endosc2023;37:9427-40

[47]

Courcoulas AP,Belle SH.Seven-year weight trajectories and health outcomes in the longitudinal assessment of bariatric surgery (LABS) study.JAMA Surg2018;153:427-34 PMCID:PMC6584318

[48]

DeMaria EJ,Warthen M.Baseline data from American society for metabolic and bariatric surgery-designated bariatric surgery centers of excellence using the bariatric outcomes longitudinal database.Surg Obes Relat Dis2010;6:347-55

[49]

Edholm D,Näslund I,Rask E.Long-term results 11 years after primary gastric bypass in 384 patients.Surg Obes Relat Dis2013;9:708-13

[50]

Angrisani L,Santonicola A,Formisano G.Long-term results of laparoscopic Roux-en-Y gastric bypass for morbid obesity: 105 patients with minimum follow-up of 15 years.Surg Obes Relat Dis2021;17:727-36

[51]

Sjöström L, Lindroos AK, Peltonen M, et al; Swedish Obese Subjects Study Scientific Group. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683-93.N Engl J Med2004;351:2683-93

[52]

Courcoulas AP,Hu B.Long-term outcomes of medical management vs bariatric surgery in type 2 diabetes.JAMA2024;331:654-64 PMCID:PMC10900968

[53]

Hage K,Ghusn W.Type 2 diabetes remission after Roux-en-Y gastric bypass: a multicentered experience with long-term follow-up.Surg Obes Relat Dis2023;19:1339-45

[54]

Yu Z,Li P,Zhang Y.Meta-analysis of long-term relapse rate of type 2 diabetes following initial remission after Roux-en-Y gastric bypass.Obes Surg2021;31:5034-43 PMCID:PMC8490229

[55]

Cui BB,Li PZ,Zhu LY.Long-term outcomes of Roux-en-Y gastric bypass versus medical therapy for patients with type 2 diabetes: a meta-analysis of randomized controlled trials.Surg Obes Relat Dis2021;17:1334-43

[56]

Nguyen NT,Lane KT,Lane JS.Association of hypertension, diabetes, dyslipidemia, and metabolic syndrome with obesity: findings from the National Health and Nutrition Examination Survey, 1999 to 2004.J Am Coll Surg2008;207:928-34

[57]

Dogan K,Homan J.Long-term effects of laparoscopic Roux-en-Y gastric bypass on diabetes mellitus, hypertension and dyslipidaemia in morbidly obese patients.Obes Surg2014;24:1835-42

[58]

Guimarães M,Silva D.How sustained is Roux-en-Y gastric bypass long-term efficacy? : Roux-en-Y Gastric Bypass efficacy.Obes Surg2021;31:3623-9 PMCID:PMC8270797

[59]

Salminen P,Ovaska J.Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss at 5 years among patients with morbid obesity: the SLEEVEPASS randomized clinical trial.JAMA2018;319:241-54 PMCID:PMC5833550

[60]

Peterli R,Peters T.Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial.JAMA2018;319:255-65 PMCID:PMC5833546

[61]

Bays H,Azagury DE.Lipids and bariatric procedures Part 2 of 2: scientific statement from the American Society for Metabolic and Bariatric Surgery (ASMBS), the National Lipid Association (NLA), and Obesity Medicine Association (OMA).Surg Obes Relat Dis2016;12:468-95

[62]

Fernandez AZ Jr,Tichansky DS.Experience with over 3,000 open and laparoscopic bariatric procedures: multivariate analysis of factors related to leak and resultant mortality.Surg Endosc2004;18:193-7

[63]

Sjöström L.Review of the key results from the Swedish Obese Subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery.J Intern Med2013;273:219-34

[64]

Cardoso L,Gomes L.Short- and long-term mortality after bariatric surgery: a systematic review and meta-analysis.Diabetes Obes Metab2017;19:1223-32

[65]

Flum DR,Elrod JA,Cheadle A.Early mortality among medicare beneficiaries undergoing bariatric surgical procedures.JAMA2005;294:1903-8

[66]

Benotti P,Winegar DA.Risk factors associated with mortality after Roux-en-Y gastric bypass surgery.Ann Surg2014;259:123-30 PMCID:PMC4075503

[67]

Ballesta C,Cabrera M,Gonzales M.Management of anastomotic leaks after laparoscopic Roux-en-Y gastric bypass.Obes Surg2008;18:623-30

[68]

Mason EE,Jiang D.Perioperative risks and safety of surgery for severe obesity.Am J Clin Nutr1992;55:573S-6

[69]

De Maria EJ, Sugerman HJ, Kellum JM, Meador JG, Wolfe LG. Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity.Ann Surg2002;235:640-5 PMCID:PMC1422489

[70]

Harakeh AB. Complications of laparoscopic Roux-en-Y gastric bypass.Surg Clin North Am2011;91:1225-37

[71]

Lee MG,Jones DB.Use of fibrin sealant in laparoscopic gastric bypass for the morbidly obese.Obes Surg2004;14:1321-6

[72]

Fullum TM,Turner PL.Decreasing anastomotic and staple line leaks after laparoscopic Roux-en-Y gastric bypass.Surg Endosc2009;23:1403-8

[73]

Odovic M,Demartines N.Early bleeding after laparoscopic Roux-en-Y gastric bypass: incidence, risk factors, and management - a 21-year experience.Obes Surg2022;32:3232-8 PMCID:PMC9532327

[74]

Zafar SN,Felton J,Kligman M.Postoperative bleeding after laparoscopic Roux en Y gastric bypass: predictors and consequences.Surg Endosc2019;33:272-80

[75]

Ioffe OY,Kryvopustov MS.Improving the management of morbidly obese patients with postoperative bleeding undergoing Roux-en-Y gastric bypass.Wiad Lek2024;77:1127-33

[76]

Mabeza RM,Verma A.Factors and outcomes associated with venous thromboembolism following bariatric surgery.Am Surg2022;88:2525-30

[77]

Mason EE,Huang YH,Samuel I.Causes of 30-day bariatric surgery mortality: with emphasis on bypass obstruction.Obes Surg2007;17:9-14

[78]

Escalante-Tattersfield T,Fajnwaks P,Rosenthal RJ.Incidence of deep vein thrombosis in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass.Surg Obes Relat Dis2008;4:126-30

[79]

Aminian A,Khorgami Z.Who should get extended thromboprophylaxis after bariatric surgery?: A risk assessment tool to guide indications for post-discharge pharmacoprophylaxis.Ann Surg2017;265:143-50

[80]

Finks JF, English WJ, Carlin AM, et al; Michigan Bariatric Surgery Collaborative, Center for Healthcare Outcomes and Policy. Predicting risk for venous thromboembolism with bariatric surgery: results from the Michigan Bariatric Surgery Collaborative. Ann Surg. 2012;255:1100-4.

[81]

Dang JT,Delisle M.Predicting venous thromboembolism following laparoscopic bariatric surgery: development of the BariClot tool using the MBSAQIP database.Surg Endosc2019;33:821-31

[82]

Aminian A, Vosburg RW, Altieri MS, Hinojosa MW, Khorgami Z; American Society for Metabolic and Bariatric Surgery Clinical Issues Committee. The American Society for Metabolic and Bariatric Surgery (ASMBS) updated position statement on perioperative venous thromboembolism prophylaxis in bariatric surgery. Surg Obes Relat Dis. 2022;18:165-74.

[83]

Arias PM,García M,Martínez Lascano F.Micronutrient deficiencies after Roux-en-Y gastric bypass: long-term results.Obes Surg2020;30:169-73

[84]

van der Burgh Y, Boerboom A, de Boer H, Witteman B, Berends F, Hazebroek E. Weight loss and malnutrition after conversion of the primary Roux-en-Y gastric bypass to distal gastric bypass in patients with morbid obesity.Surg Obes Relat Dis2020;16:381-8

[85]

van der Beek ES, Monpellier VM, Eland I, Tromp E, van Ramshorst B. Nutritional deficiencies in gastric bypass patients; incidence, time of occurrence and implications for post-operative surveillance.Obes Surg2015;25:818-23

[86]

Bjerkan KK,Nymo S.Vitamin and mineral deficiency 12 years after Roux-en-Y gastric bypass a cross-sectional multicenter study.Obes Surg2023;33:3178-85 PMCID:PMC10514116

[87]

Mechanick JI,Brethauer S.Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists.Surg Obes Relat Dis2020;16:175-247

[88]

Brockmeyer, JR, Kothari, SN. Marginal and peptic ulcers: prevention, diagnosis, and management. In: Herron D. Editor. Bariatric surgery complications and emergencies. New York: Springer; 2016. pp. 147-159.

[89]

Abell TL.Gastrointestinal complications of bariatric surgery: diagnosis and therapy.Am J Med Sci2006;331:214-8

[90]

Coblijn UK,Lagarde SM,van Wagensveld BA.Development of ulcer disease after Roux-en-Y gastric bypass, incidence, risk factors, and patient presentation: a systematic review.Obes Surg2014;24:299-309

[91]

Csendes A,Altuve J.Incidence of marginal ulcer 1 month and 1 to 2 years after gastric bypass: a prospective consecutive endoscopic evaluation of 442 patients with morbid obesity.Obes Surg2009;19:135-8

[92]

Gumbs AA,Bell RL.Incidence and management of marginal ulceration after laparoscopic Roux-Y gastric bypass.Surg Obes Relat Dis2006;2:460-3

[93]

Altieri MS, Carter J, Aminian A, et al; Clinical Issues Committee of the American Society for Metabolic and Bariatric Surgery. American Society for Metabolic and Bariatric Surgery literature review on prevention, diagnosis, and management of internal hernias after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2023;19:763-71.

[94]

Kristensen SD,Naver L,Floyd AK.Randomized clinical trial on closure versus non-closure of mesenteric defects during laparoscopic gastric bypass surgery.Br J Surg2021;108:145-51

[95]

Aghajani E,Leifson BG,Gislason H.The mesenteric defects in laparoscopic Roux-en-Y gastric bypass: 5 years follow-up of non-closure versus closure using the stapler technique.Surg Endosc2017;31:3743-8 PMCID:PMC5579176

[96]

Frøkjær JB,Holt G,Olesen SS.The diagnostic performance and interrater agreement of seven CT findings in the diagnosis of internal hernia after gastric bypass operation.Abdom Radiol2018;43:3220-6

[97]

Zaigham H,Regnér S.Long-term follow-up and risk of recurrence of internal herniation after Roux-en-Y gastric bypass.Obes Surg2023;33:2311-6 PMCID:PMC10344975

[98]

Dai Y,Li W.Incidence and risk factors for cholelithiasis after bariatric surgery: a systematic review and meta-analysis.Lipids Health Dis2023;22:5 PMCID:PMC9840335

[99]

Leyva-Alvizo A, Arredondo-Saldaña G, Leal-Isla-Flores V, et al; ASMBS Foregut Committee. Systematic review of management of gallbladder disease in patients undergoing minimally invasive bariatric surgery. Surg Obes Relat Dis. 2020;16:158-64.

[100]

Xia C,Lv H.The safety and necessity of concomitant cholecystectomy during bariatric surgery in patients with obesity: a systematic review and meta-analysis.Obes Surg2021;31:5418-26

[101]

Pizza F,Lucido FS.The role of ursodeoxycholic acid (UDCA) in cholelithiasis management after one anastomosis gastric bypass (OAGB) for morbid obesity: results of a monocentric randomized controlled trial.Obes Surg2020;30:4315-24

[102]

Edwards MA,Vosburg RW.American Society for Metabolic and Bariatric Surgery: postoperative care pathway guidelines for Roux-en-Y gastric bypass.Surg Obes Relat Dis2025;21:523-36

[103]

Callahan ZM,Kuchta K,Carbray J.Five-year results of endoscopic gastrojejunostomy revision (transoral outlet reduction) for weight gain after gastric bypass.Surg Endosc2020;34:2164-71

[104]

Bazarbashi AN,McCarty TR,Thompson CC.Endoscopic revision of gastrojejunal anastomosis for the treatment of dumping syndrome in patients with Roux-en-Y gastric bypass: a systematic review and meta-analysis.Surg Endosc2022;36:4099-107 PMCID:PMC9018893

[105]

Dolan RD,Thompson CC.Endoscopic versus surgical gastrojejunal revision for weight regain in Roux-en-Y gastric bypass patients: 5-year safety and efficacy comparison.Gastrointest Endosc2021;94:945-50 PMCID:PMC8908793

[106]

Gallo AS,Berducci MA.Endoscopic revision of gastric bypass: holy Grail or Epic fail?.Surg Endosc2016;30:3922-7

[107]

Fischbach RN,Dun N. A manual of laboratory and diagnostic tests. 9th ed. Lippincott Williams & Wilkins; 2015. Available from: https://www.amazon.com/Manual-Laboratory-Diagnostic-Tests/dp/1451190891#. [Last accessed on 26 May 2025].

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