Evolution of minimally invasive bariatric surgery.
BACKGROUND
Minimally invasive Roux-en-Y gastric bypass is a procedure that is being performed with increasing frequency. It is an advanced laparoscopic procedure with a steep learning curve. With experience, it can be performed in a reasonable amount of time with minimal morbidity.


METHODS
We first performed minimally invasive gastric bypass with the hand-assisted laparoscopic surgery (HALS) technique. After significant experience with HALS, we changed our approach to completely laparoscopic (LS). Our technique for all cases involves a circular stapled gastrojejunostomy with a 25-mm anvil passed transgastrically.


RESULTS
From June 1998 to January 2002, 304 patients underwent minimally invasive gastric bypass. Our first 81 cases were with HALS, and the rest were LS. The incidence of early major and minor perioperative complications for the entire series was 5.6% and 7.9%, respectively. Early reoperation (less than 30 days) was required in 4.6% of all patients. There was 1 leak (1.2%) in the HALS group and 4 anastomotic leaks (1.8%) in the LS group. Other measured outcomes were similar in each group with the exception of wound hernia (16% HALS vs 0.9% LS). Weight loss after 1 year was 44% for HALS and 56% for LS. We have not had any deaths in our series.


CONCLUSIONS
HALS may have certain advantages in selected patients and early in a surgeon's experience with minimally invasive gastric bypass. With experience, good results are possible with either approach.
Gould
Jon C
JC
Department of Surgery and the Center for Minimally Invasive Surgery, The Ohio State University School of Medicine and Public Health, Columbus, Ohio 43210, USA.
Needleman
Bradley J
BJ
Ellison
E Christopher
EC
Muscarella
Peter
P
Schneider
Carol
C
Melvin
W Scott
WS
D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000379:methods / Q000639:trends; D015390:Gastric Bypass / Q000379:methods* / Q000639:trends; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000639:trends; D007902:Length of Stay; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods* / Q000639:trends; D011183:Postoperative Complications / Q000145:classification; D012086:Reoperation; D012189:Retrospective Studies