Original article Detailed description of early response of metabolic syndrome after laparoscopic Roux-en-Y gastric bypass Mohamed R. Ali, M.D.*, William D. Fuller, M.D., Jason Rasmussen, M.D. Department of Surgery, University of California, Davis, School of Medicine, Sacramento, California Received May 13, 2008; revised September 3, 2008; accepted October 20, 2008 Abstract Background: Previous outcome research in bariatric surgery has been unable to document quan- titative changes in co-morbidities associated with obesity owing to a lack of a standardized instrument to grade the severity. We report a detailed description of the early resolution of the metabolic syndrome using our novel scheme for assessing co-morbidities. This study was performed at a tertiary care university hospital. Methods: Co-morbidity data were prospectively collected for 827 patients who underwent lapa- roscopic Roux-en-Y gastric bypass during a 4-year period using the Assessment of Obesity-Related Co-morbidities (AORC) scale. This scale assigns a score of 0 –5 for the major medical conditions associated with obesity. The co-morbid conditions of obesity and biochemical markers of the metabolic syndrome were examined preoperatively and at the follow-up visits. Results: Of the 827 patients who underwent laparoscopic Roux-en-Y gastric bypass, 72 (8.7%) met the AORC criteria for the metabolic syndrome (AORC score 2 for diabetes mellitus [DM], hypertension [HTN], and dyslipidemia [DYS]). Overall, 75% of patients with DM, 69.4% of patients with HTN, and 76.4% of patients with DYS showed improvement in these co-morbidities (decrease from the preoperative AORC score) within 2 months after surgery. Within this period, DM, HTN, and DYS resolved in 65.3%, 51.4%, and 73.6% of patients, respectively. Concurrent decreases in hemoglobin A1c, serum lipids, and blood pressure were observed (P .05). Patients exhibited a modest excess body weight loss of 27.7% during this period. However, the mean AORC score for the whole group decreased significantly for DM, DYS, and HTN (P .001) before significant weight loss occurred. Conclusion: We have demonstrated a new and novel approach to categorize and more accurately define the magnitude of improvement in co-morbidities after laparoscopic Roux-en-Y gastric bypass. This improvement preceded the weight loss effects on the metabolic syndrome. (Surg Obes Relat Dis 2009;5:346 –351.) © 2009 American Society for Metabolic and Bariatric Surgery. All rights reserved. Keywords: Bariatric surgery; Roux-en-Y gastric bypass; Laparoscopy; Co-morbidities; Morbid obesity; Metabolic syn- drome; Diabetes mellitus; Hyperlipidemia; Hypertension The epidemic of medically complicated obesity has led to increasing recognition of the metabolic syndrome and its effect on the health of patients. This syndrome combines central obesity with the constellation of impaired glucose and lipid metabolism, as well as hypertension (HTN), and has become an important clinical entity within the con- text of the medical conditions associated with obesity [1–3]. The importance of this condition cannot be over- stated; it has been estimated to occur in as many as 35–39% of American adults seeking bariatric surgery, and it is prevalent in more than one half of severely obese individuals [4 – 6]. Furthermore, the effects of the metabolic syndrome on the cardiovascular morbidity and mortality of these patients is considerable [2,3,7]. *Reprint requests: Mohamed R. Ali, M.D., Assistant Professor of Surgery, Director, Minimally Invasive Surgery, Department of Surgery, University of California, Davis, 2221 Stockton Boulevard, Cypress Build- ing, Sacramento, CA 95817. E-mail: mohamed.ali@ucdmc.ucdavis.edu Surgery for Obesity and Related Diseases 5 (2009) 346 –351 1550-7289/09/$ – see front matter © 2009 American Society for Metabolic and Bariatric Surgery. All rights reserved. doi:10.1016/j.soard.2008.10.014