title: Introducing laparoscopic Roux-en-Y gastric bypass at a Veterans Affairs medical facility.
abstract: BACKGROUND
  Previous studies have shown that advanced age, diabetes, and male gender are associated with higher morbidity and mortality after bariatric surgery. Those risk factors are characteristic of patients in the Veterans Affairs (VA) health care system. Laparoscopic Roux-en-Y gastric bypass (RYGB) has become an established treatment modality for morbid obesity. Our objective was to review the initial experience with laparoscopic (RYGB) for morbid obesity at our VA facility.
  
  
  METHODS
  A retrospective review was used.
  
  
  RESULTS
  Between May of 2002 and April of 2004, 40 patients underwent laparoscopic RYGB. All patients met National Institutes of Health consensus statement guidelines for bariatric surgery. There were 30 (75%) male and 10 (25%) female patients, with an average age of 49.9 +/- 8.7 years and an average body mass index (BMI) of 48.1 +/- 8.5 kg/m(2). Preoperative comorbidities included diabetes mellitus (DM) in 59%, hypertension in 79%, and obstructive sleep apnea in 74.4%. The procedure was converted to an open procedure in 3 patients (7.5%). There were no mortalities. Immediate (within 30 days) complications developed in 9 (22.5%) patients, necessitating abdominal re-operation in 3 patients (7.5%). The median length of hospital stay was 3 days. Late complications (>30 days) developed in 8 (20%) patients. Percent excess weight loss at 3, 6, and 12 months was 44% (n = 34), 59% (n = 29), and 70.0% (n = 22), respectively. In 23 patients who were followed-up for more than 3 months, DM resolved in 79% and improved in 21% at a mean follow-up evaluation of 13 months.
  
  
  CONCLUSIONS
  Laparoscopic RYGB can be performed with acceptable morbidity and with good short-term results in a VA hospital setting. Morbid obesity is prevalent in the VA patient population and access to bariatric surgery should be an available alternative.
authors.affiliation: Stanford University School of Medicine, Palo Alto, CA, USA; VA Palo Alto Health Care System, 3801 Miranda Ave., 112G, Palo Alto, CA 94304, USA. bsafadi@stanford.edu
authors.forename: Bassem Y
authors.initials: BY
authors.lastname: Safadi
authors.forename: Jennefer A
authors.initials: JA
authors.lastname: Kieran
authors.forename: Robert G
authors.initials: RG
authors.lastname: Hall
authors.forename: John M
authors.initials: JM
authors.lastname: Morton
authors.forename: Nina
authors.initials: N
authors.lastname: Bellatorre
authors.forename: Evelyn
authors.initials: E
authors.lastname: Shinoda
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Johnson
authors.forename: Myriam J
authors.initials: MJ
authors.lastname: Curet
authors.forename: Sherry M
authors.initials: SM
authors.lastname: Wren
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000379:methods; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D006787:Hospitals, Veterans; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D015431:Weight Loss