Laparoscopic Roux-en-Y Gastric Bypass: Preoperative Determinants of Prolonged Operative Times, Conversion to Open Gastric Bypasses, and Postoperative Complications

Schwartz, Michael L.; Drew, Raymond L; Chazin-Caldie, Marilyn

doi:10.1381/096089203322509309

Cited by 83 publications

(41 citation statements)

References 3 publications

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“…[10][11][12] Indeed, an enlarged liver has been reported to be the most common cause for conversion to an open procedure during laparoscopic gastric bypass and gastric banding. 13,14 Several studies have shown a significant reduction in liver volume after a pe-riod of low caloric intake by restriction to a very lowcalorie diet (VLCD) or by the use of an intragastric balloon. 13,14 In the presurgical setting, a VLCD has been shown to result in rapid weight loss 15 without compromising immune function 16 or wound healing 8 and with few adverse effects.…”

Section: Discussionmentioning

confidence: 99%

“…13,14 Several studies have shown a significant reduction in liver volume after a pe-riod of low caloric intake by restriction to a very lowcalorie diet (VLCD) or by the use of an intragastric balloon. 13,14 In the presurgical setting, a VLCD has been shown to result in rapid weight loss 15 without compromising immune function 16 or wound healing 8 and with few adverse effects. 9 It has been reported that 80% of the decrease in liver volume in response to the intake of a VLCD for 12 weeks is achieved already after the first 2 weeks.…”

Section: Discussionmentioning

confidence: 99%

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Preoperative Very Low-Calorie Diet and Operative Outcome After Laparoscopic Gastric Bypass

Dambrauskas²,

et al. 2011

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Preoperative Very Low-Calorie Diet and Operative Outcome After Laparoscopic Gastric Bypass

Dambrauskas²,

et al. 2011

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“…54,55 However, higher BMI should still be an important consideration in patient selection, as it correlates with a higher prevalence of comorbidities, longer operative times, and higher rates of conversion to open procedures. 56 In conclusion, presence of diabetes, open surgery, and early surgeon experience are associated with increased risk of complications after GBP. Routine proctoring of a surgeon's early experience and increased use of laparoscopic techniques may decrease complication rates.…”

Section: Commentmentioning

confidence: 91%

Spectrum and Risk Factors of Complications After Gastric Bypass

Campos

Ciovica²,

Rogers³

et al. 2007

Arch Surg

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Main Outcome Measures: Complications were stratified by grade: grade I, only bedside procedure; grade II, therapeutic intervention but without lasting disability; grade III, irreversible deficits; and grade IV, death. Data were analyzed using logistic regression to identify independent risk factors of complications after GBP. Predictors investigated were age, race, sex, marital and insurance status, body mass index, obesity-associated comorbidities, American Society of Anesthesiologists Physical Status Class, operating room time, open or laparoscopic approach, and surgeon experience. Results: Of the 404 morbidly obese patients who underwent consecutive open (n = 72) or laparoscopic (n = 332) GBP, 74 (18.3%) experienced 107 complications. Grade I and II complications were more frequent after open GBP (grade I, 19.4% after open vs 3.9% after laparoscopic operations, PϽ .001; grade II, 20.8% after open vs 8.4% after laparoscopic operations, PϽ.001), and 55% were wound related. Grades III and IV complications occurred in only 4 patients (1%), and frequency was similar for open and laparoscopic cases. Three factors were independently predictive of complications: diabetes mellitus

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“…Key elements of the 2 most common obesity surgery procedures in the world today, Roux-en-Y gastric bypass (RYGBP) and the laparoscopic adjustable gastric band (LAGB), require exposure and surgery in the area of the gastroesophageal junction. Hepatomegaly has been cited as the most common cause for conversion to an open procedure from laparoscopic RYGBP (8) and LAGB placement (9). Surgeons at our center estimate that hepatomegaly increases surgical difficulty in Ȃ10 -20% of cases, and excessive omental fat, covering the structures of the left-upper quadrant of the abdomen, provides an additional technical challenge.…”

Section: Introductionmentioning

confidence: 99%

Preoperative weight loss with a very-low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging

Colles

Dixon

Marks

et al. 2006

The American Journal of Clinical Nutrition

294

153

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Background: A very-low-energy diet (VLED) can result in substantial, rapid weight loss and is increasingly prescribed before obesity surgery to minimize risk and difficulty by reducing liver size and abdominal adiposity. Despite its growing popularity, a VLED in this setting has received little attention. Objective: The aim of this study was to investigate the efficacy and acceptability of a preoperative VLED. Design: In a prospective observational study, 32 subjects (n ҃ 19 men and 13 women) with a mean (ȀSD) age of 47.5 Ȁ 8.3 y and a body mass index (in kg/m 2 ) of 47.3 Ȁ 5.3 consumed a VLED for 12 wk. Primary outcomes included changes in liver volume (LV) and in visceral and subcutaneous adipose tissue (VAT/SAT). Changes in body weight, anthropometric measures, and biochemical variables were also recorded, and compliance with, acceptability of, and side effects of treatment were assessed. Changes in LV and VAT/SAT area were measured by computed tomography and magnetic resonance imaging at baseline and weeks 2, 4, 8, and 12. Results: Mean (ȀSD) LV, VAT/SAT, and body weight decreased significantly (P 0.001 for all). The degree of LV reduction was directly related to the reduction in relative body weight (r ҃ 0.54, P ҃ 0.001) and initial LV (r ҃ 0.43, P ҃ 0.015). Eighty percent of the reduction in LV occurred between weeks 0 and 2 (P 0.001). Reductions in body weight and VAT were uniform over the 12-wk period. Attrition was 14%. Acceptability was adequate but waned over time, and mild transitory side effects occurred. Conclusions: Given the observed early reduction in LV and the progressive reduction in VAT, we suggest that the minimum duration for a preoperative VLED be 2 wk. Ideally, the duration should be 6 wk to achieve maximal LV reduction and significant reductions in VAT and body weight without compromising compliance and acceptability.Am J Clin Nutr 2006;84:304 -11.

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Laparoscopic Roux-en-Y Gastric Bypass: Preoperative Determinants of Prolonged Operative Times, Conversion to Open Gastric Bypasses, and Postoperative Complications

Cited by 83 publications

References 3 publications

Preoperative Very Low-Calorie Diet and Operative Outcome After Laparoscopic Gastric Bypass

Preoperative Very Low-Calorie Diet and Operative Outcome After Laparoscopic Gastric Bypass

Spectrum and Risk Factors of Complications After Gastric Bypass

Preoperative weight loss with a very-low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging

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