Results of 281 Consecutive Total Laparoscopic Roux-en-Y Gastric Bypasses to Treat Morbid Obesity

Abstract

ObjectiveTo determine the safety and efficacy of laparoscopic Rouxen-Y gastric bypass for the treatment of morbid obesity. Summary Background DataLaparoscopic Roux-en-Y gastric bypass is a new and technically challenging surgical procedure that requires careful study. MethodsThe authors attempted total laparoscopic Roux-en-Y gastric bypass in 281 consecutive patients. Procedures included 175 proximal bypasses, 12 long-limb bypasses, and 9 revisional procedures from previous bariatric operations. The gastrojejunostomy and jejunojejunostomy were primarily constructed using linear stapling techniques. ResultsEight patients required conversion to an open procedure (2.8%). The mean age of the patients was 41.6 years (range 15-71) and 87% were female. The mean preoperative body mass index was 48.1 kg/m 2 . The operative time decreased significantly from 234 Ϯ 77 minutes in the first quartile to 162 Ϯ 42 minutes in the most recent quartile. Postoperative length of stay averaged 4 days (range 2-91), with 75% of patients discharged within 3 days. The median hospital stay was 2 days. No patient died after surgery. Complications included three (1.5%) major wound infections (each followed a reoperation for a complication or open conversion), incisional hernia in 5 patients (1.8%), and anastomotic leak with peritonitis in 14 patients (5.1%). Three gastrojejunal leaks were managed without surgery, four by laparoscopic repair/drainage, and three by open repair/drainage. Only three patients had anastomotic leaks in the most recent 164 procedures (1.8%) since the routine use of a two-layer anastomotic technique. Data at 1 year after surgery were available in 69 of 96 (72%) patients (excludes revisions). Weight loss at one year was 70 Ϯ 5% of excess weight. Most comorbid conditions resolved by 1 year after surgery; notably, 88% of patients with diabetes no longer required medications. ConclusionsLaparoscopic gastric bypass demonstrates excellent weight loss and resolution of comorbidities with a low complication rate. The learning curve is evident: operative time and leaks decreased with experience and improved techniques. The primary advantage is an extremely low risk of wound complications, including infection and hernia.Laparoscopic gastric bypass surgery to treat morbid obesity is a promising but technically demanding and complex minimally invasive procedure. To date, several publications have suggested the procedure can be done with safety and potential benefit, particularly in terms of decreased woundrelated complications, including infections and hernias, at least with short-term follow-up. [1][2][3][4][5] We have had extensive experience with open gastric bypass surgery and maintain a database with more than 2,500 patients, many followed up to 15 years after surgery. We and others have published outcome data for open gastric bypass surgery with outstanding outcomes. 6 -12 Our goal in developing our laparoscopic gastric bypass program was to introduce the procedure while avoiding increased risk for

Validation that a 1-year fellowship in minimally invasive and bariatric surgery can eliminate the learning curve for laparoscopic gastric bypass

“…The other two mentor faculty, both with extensive experience with open gastric bypass over many years, began to perform LRYGB closer to initiation of the fellowship, with the assistance of their experienced colleague. While it is possible that the MI faculty had not completely climbed their own learning curves for LRYGB during the early period of fellowship training and that this could represent a bias in the current study, the MI demonstrated CRO for LRYGB comparable to other published benchmark data for cases performed during the period of training [25]. Specifically, the rates of significant complications for the MI, detailed in Table 2, were within the ranges established in landmark publications describing experience with LRYGB [26][27][28].…”

Evidence-based medicine reports on obesity surgery: a critique

“…This report fails to mention the shorter length of hospital stay, the significant decrease in pain, and wound complications the early improvement in quality of life and earlier return to work with the laparoscopic approach. [79][80][81][82][83] When evaluating the adjustable laparoscopic gastric band, the authors of the TEC report fail to mention the significantly lower postoperative mortality of 0.05% 97-100 as compared to either the open or laparoscopic gastric bypass (0.5-2%).…”

“…Thus, placement of an adjustable laparoscopic gastric band may be safer for frail, high-risk patients. When analyzing the risks and benefits of laparoscopic gastric bypass, the early benefits of the laparoscopic vs the open approach [79][80][81][82][83] were ignored in the TEC study, through not including decreased postoperative pain, decreased wound complications and earlier improvements in quality of life and return to work. The significant benefits of the laparoscopic approach are driving patients to choose laparoscopicoperations.…”

Análise radiológica das alterações gastrintestinais após cirurgia de Fobi-Capella

“…Stenosis of gastrojejunal anastomosis was found in only one patient (2.4%), a little below the percentages reported by the literature (3-27%) (14-18) . DeMaria et al have evaluated 281 patients and reported this event in 6.6% of cases (17) . Ulcers may be caused by exposure to gastric acids from the gastrojejunal anastomosis or by ischemia.…”