Perioperative Morbidity, Mortality and Early Outcome of the First 360 Gastric Bypass Operations Performed in a District Hospital

Abstract

Background and Aims: We report the results for the first consecutive 360 roux-en-y gastric bypass (rygb) operations performed in a district hospital in finland.Material and Methods: demographic data, perioperative characteristics, and follow-up data were entered prospectively in the hospital's database for bariatric patients.Results: We performed 325 primary laparoscopic roux-en-y gastric bypass (lrygb) operations, one open rygb, and 34 revisions. mean bmi before the operations was 47.5 ± 7.8 kg/m 2 (31.5-91.0 kg/m 2 ). the percentage of patients with type 2 diabetes mellitus (t2dm) was high; 52.3% (170 patients). the mean operative time decreased from 110 minutes during the first 108 operations to 82 minutes for the second 108 operations, and to 74 minutes for the last 109 operations (P < 0.001). Postoperative hospital stay was significantly reduced (P < 0.001) for the last 109 patients compared to the first and second group of patients. overall morbidity averaged 19.1% (62/325). severe complications were detected in 15 patients (4.6%). there was a tendency to more serious complications in the first group of patients. there was one death (mortality 0.3%). With a follow-up rate of 97% at 3 months t2dm had resolved in 48.2%, and had resolved or improved in a minimum of 92.9% of the diabetic patients. Weight loss (Wl) and excess weight loss (eWl) averaged 20% and 46% respectively.Conclusions: operative time and postoperative hospital stay decrease significantly with increasing experience. the first one hundred patients may be at higher risk for complications. lrygb operations may have an important impact on the resolution of t2dm in the operated population.

Outcome of Laparoscopic Gastric Bypass (LRYGB) with a Program for Enhanced Recovery After Surgery (ERAS)

“…We have previously reported our results following primary LRYGB in 325 patients during the learning curve [25]. During that time, the LOS dropped from 4 days during the first 108 operations to 2 days during the last 109 patients, and the mean operative time from 110 to 74 min.…”

Short-term outcome of laparoscopic cholecystectomy for benign gall bladder diseases in 76 dogs

“…Finally, we speculate that the learning curve of this procedure prolonged the operative time. A steep learning curve has previously been reported for some laparoscopic surgeries [ 10 , 13 , 18 , 19 ]. Several reports have shown that experience and standardization lead to good outcomes, including the shortening of the operative time and improvement of perioperative outcomes.…”

Laparoscopic Roux-En-Y Gastric Bypass Versus Laparoscopic Adjustable Gastric Banding in the Super-Obese: Peri-Operative and Early Outcomes

“…It may be associated with a shorter learning curve and a lower early postoperative complication rate compared to LRYGB (6, 23). On the other hand, LRYGB has shown to be safe even in the learning curve period and more effective than LAGB in maintaining WL in the long term (24, 25).…”

“…Moreover, the study is not adequately powered in order to draw definitive conclusions. It is also difficult to evaluate the possible impact of the learning curve on the results, as 11 of the super-obese patients undergoing LRYGB were operated during our learning curve period for this procedure (24). Another potential bias may come from the proportion of patient lost to follow-up, which is known to create a particular challenge in assessing bariatric surgical outcomes, as it is likely that the bariatric surgery patients who are not doing well are the most hesitant to return for follow-up (33).…”