Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity.
OBJECTIVE
To determine the safety and efficacy of laparoscopic Roux-en-Y gastric bypass for the treatment of morbid obesity.


BACKGROUND
Laparoscopic Roux-en-Y gastric bypass is a new and technically challenging surgical procedure that requires careful study.


METHODS
The 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.


RESULTS
Eight 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/m2. The operative time decreased significantly from 234 +/- 77 minutes in the first quartile to 162 +/- 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 +/- 5% of excess weight. Most comorbid conditions resolved by 1 year after surgery; notably, 88% of patients with diabetes no longer required medications.


CONCLUSIONS
Laparoscopic 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.
DeMaria
Eric J
EJ
Department of Surgery and the Center for Minimally Invasive Surgery, Medical College of Virginia Campus of Virginia Commonwealth University, Richmond, Virginia 23298, USA. edemaria@hsc.vcu.edu
Sugerman
Harvey J
HJ
Kellum
John M
JM
Meador
Jill G
JG
Wolfe
Luke G
LG
D000328:Adult; D000713:Anastomosis, Roux-en-Y; D015897:Comorbidity; D005260:Female; D015390:Gastric Bypass / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss