Laparoscopic gastric bypass: development of technique, respiratory function, and long-term outcome.
BACKGROUND
Roux-en-Y gastric bypass (RYGBP) is the preferred operation for the treatment of morbid obesity by many surgeons. Hereby we present the process by which laparoscopic RYGBP (LRYGBP) developed at our institution.


METHODS
Perioperative morbidity was recorded from 150 consecutive morbidly obese patients operated upon by RYGBP from August 1994 to March 2002. The first 76 consecutive patients have been followed up to 5 years postoperatively. A subgroup of 40 patients was recruited to evaluate the postoperative lung function in a randomized study between receiving and not receiving prophylactic chest physiotherapy.


RESULTS
In the whole series, there were 4 conversions to open surgery, 5 leaks, 12 postoperative bleedings and 1 intestinal obstruction. 1 patient succumbed after developing acute dilatation of the bypassed stomach. Respiratory function deteriorated significantly in all patients in the early postoperative period, irrespective if given physiotherapy. During the follow-up period, 3 patients developed mechanical obstruction of the Roux limb. Another patient had a perforated ulcer at the proximal pouch. Weight reduction averaged 70% of excess body weight at 2 years after surgery.


CONCLUSIONS
LRYGBP is an effective treatment for morbid obesity. During the initial development, we experienced a number of serious complications. The complication rate decreased over time. Postoperative lung function was markedly impaired, but there were no beneficial effects of chest physiotherapy. Long-term weight loss after LRYGBP seems to be comparable to what has been reported after open RYGBP.
Olbers
Torsten
T
Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden. torsten.olbers@vgregion.se
Lönroth
Hans
H
Fagevik-Olsén
Monika
M
Lundell
Lars
L
D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects / Q000379:methods; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D011336:Probability; D011659:Pulmonary Gas Exchange; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss