We embarked on this programme because of poor functional results and unsatisfactory weight loss which we observed in a proportion of patients undergoing the more traditional vertical banded gastroplasty. Recently, a consensus document produced for the Department of Health by The University of York on the treatment of obesity has confirmed the superior results of the Roux-en-Y gastric bypass over the vertical banded gastroplasty in 6 out of 7 published randomised controlled clinical trials. The jejuno-ileal bypass is now generally outlawed as an isolated procedure because of the risk of intractable diarrhoea and liver dysfunction.

Diarrhoea has not been a problem and we would consider the hypoglycaemic dumping which occurs in response to carbohydrate ingestion (identical to the post-gastrectomy syndrome) to be an advantage of the operation.

Our complication rate is under 10% and mortality under 0.3%. The average BMI at the time of surgery is 51 kg/m². We have seen no treatment failures (loss of less than 25% of maximum weight at a year); our mean weight loss at 12 months is 40% of the patient's starting weight.

We do not consider the operation primarily as a cosmetic procedure, but as an effective and durable treatment for the co-morbidity associated with severe obesity.

Obesity surgery is not widely practised in the U.K. Although over 44,000 gastric bypasses were performed last year in America, compared with 121 in Leeds, our results compare favourably with the best published American series.

We have follow-up of over a year in over 200 patients. In addition to a predicted reduction in cardiac mortality of 1-2% per pound lost (based on the Framingham Heart Study data) we have seen a major impact on comorbidity, based on the responses to our follow-up questionnaire.

Co-morbidity Incidence Resolved or markedly improved

Hypertension 33% 79%

Arthritis 55% 87%

Disturbed sleep/snoring/ sleep apnoea 59% 85%

Depression 35% 82%

Urinary incontinence 39% 65%

Diabetes 11% 95%

Poor exercise tolerance 75% 95%

Poor self esteem 82% 95%

95.5% of patients were satisfied (9%) or very satisfied (86.5%) with the procedure;
96.5% would recommend the procedure to other patients.