Recently, the most successful weight loss outcomes have been obtained by combining the gastric restrictive procedure with a very limited intestinal bypass -- so called "Gastric Restrictive Procedure with Gastric Bypass for Morbid Obesity; with Short Limb (75 to 150 cm) Roux-en-Y Gastroenterostomy" (more commonly referred to as simply the Roux-en-Y Gastric Bypass Procedure). This procedure currently is giving the best short- and long-term results.

Operative mortality has been reported to range from 0.3 to 1.6 percent. Stenosis of the gastrojejunal anastomosis has been reported to occur in between 5 and 7 percent of patients within the first 18 months. Usually one to three balloon dilatations are sufficient for long term correction of the stenosis.

The average excess weight loss is expected to be 15 percent at one month, 31 percent at three months, 47 percent at six months, and 60 percent at nine months with maintenance of this weight loss documented over 14 years of follow up.

The hospital stay following the operation ranges from two to three days.

Laparoscopic Roux-en-Y Gastric Bypass

Since first described by Wittgrove in 1971, the laparoscopic approach to Roux-en-Y Gastric Bypass has rapidly become the procedure of choice. When compared to an open procedure, where an upper midline incision is made, the laparoscopic approach avoids potential serious wound complications, shortens hospital stay, and results in a more rapid recovery of normal function and return to work.

Conversion rates to an open procedure reported in the literature range from 0 to 10.3 percent and anastomotic leak rates range from 1.2 to 6.9 percent. The average excess weight loss is identical to the open procedure. The average hospital length of stay following the operation ranges from two to three days. Usually a 75 to 100 cm Roux-en-Y limb is created, however for the very obese patients, up to 200 cm may be bypassed to increase malabsorption and enhance total weight loss.

Bilopancreatic Bypass or Duodenal Switch Procedure

A Biliopancreatic bypass duodenal switch has been proposed by some as another possible approach to the surgical management of super obesity. Reported weight loss has been slightly greater than for the average weight loss following Roux-en-Y Gastric Bypass, however metabolic and nutritional disturbances have been seen with this procedure and there is little long-term results available. If it is indicated in any patient, it would be one who is markedly overweight.