A type of weight loss surgery, Roux-en-Y gastric bypass (RYGB), reduces the size of a patient's stomach to a pouch roughly the size of an egg. While most people report improved well-being after RYGB surgery, many patients experience symptoms and nearly a third are hospitalized, according to a new Aarhus University Hospital study.

"Our study showed that 87.4 percent of the patients reported that they felt better after RYGB surgery," concluded Dr. Sigrid Bjerge Gribsholt and her co-authors. "Nevertheless, 88.6 percent of patients reported one or more symptoms (mild to severe) a median of 4.7 years after RYGB surgery." Because it is effective, RYGB surgery is commonly recommended for the morbidly obese, explain the researchers.

During the procedure, a surgeon staples off a portion of the stomach to create a pouch, which is then attached directly to the small intestine, bypassing most of the rest of the stomach and part of the small intestine. As described by Johns Hopkins Health Library, the resulting small pouch curtails the amount of food a patient can eat, while the bypass further boosts a patient's weight loss potential by reducing calories and fat absorbed from consumed foods.

The most common symptoms reported in previous studies of the procedure have been gallstones and kidney stones, the researchers said; well-known side effects include anemia, hypoglycemia, dumping syndrome, diarrhea, and peripheral neuropathy. For the purposes of prevention, the researchers wondered, Which symptoms are most common today and what conditions predict them?

Pain and Fatigue

Gribsholt and her colleagues surveyed 2,238 patients who underwent RYGB surgery between January 2006 and December 2011 in a region of Denmark. Of these patients, 1,429 responded to the questionnaire. For comparison, the research team surveyed 89 individuals who did not undergo RYGB surgery, yet roughly matched the patient group in terms of age and weight. The team measured prevalence and severity of symptoms following a RYGB procedure.

About nine out of 10 patients reported one or more symptoms within 4.7 years, on average, after RYGB surgery. Abdominal pain (34 percent), fatigue (34 percent), anemia (28 percent), and gallstones (16 percent) ranked as the most commonly reported symptoms. Compared to 7 percent of the comparison group, 29 percent of RYGB patients had to be hospitalized during the study period. Most patients (87 percent) said their well-being improved after the procedure, while 8 percent said it had been reduced. Quality of life, as might be expected, directly related to the number of symptoms.

So who was most likely to experience problems following the procedure? Symptom risk was higher for women, patients younger than 35, smokers, the unemployed, and anyone with surgical symptoms beforehand, the researchers said.

Though the study group was large, the team noted only 64 percent of patients completed the questionnaire; these results, then, cannot be viewed as definitive. The researchers concluded health care providers might focus on quality of life among patients experiencing many symptoms to help them avoid depression.

Source: Gribsholt SB, Pedersen AM, Svensson E, Thomsen RW, Richelsen B. Prevalence of Self-reported Symptoms After Gastric Bypass Surgery for Obesity. JAMA Surg. 2016.