Factors determining conversion from laparoscopic to open Roux-en-Y gastric bypass.
BACKGROUND
Conversion from laparoscopic to open Roux-en-Y gastric bypass (RYGBP) is expensive and time-consuming.


METHODS
Data from our first 1,000 laparoscopic RYGBP was entered into a database (Minnesota Database-Bariatric, Exemplo Medical). All patients met NIH criteria for bariatric surgery.


RESULTS
41 (4.1%) of 1,000 consecutive lapRYGBPs were converted to open. Patients requiring conversion to open surgery, analyzed for predictors, revealed: 1) BMI, waist size, and weight all were significantly greater in patients converted to open bypass; 2) Gender: 9 of 109 males (8.3%) and 32 of 891 females (3.6%) were converted (Fischer's exact test, P=0.035); 3) Average age of patients converted was 44.9 compared to 41.3 in the lap group (P=0.02); 4) Conversion was required for 12 large livers (1 palpable preop, 7 had diabetes, 7 had NASH or steatosis); 5) 10 conversions for mechanical/technical reasons - 6 for inability to distend abdominal wall and/or manipulate instruments due to thickness of wall, and 2 due to loss of instruments in abdomen; 6) 9 required conversion for adhesions (2 from previous cholecystectomies with biliary leaks, and 1 from previous transverse colectomy; 7) 4 visceral injuries required conversion (2 stomach, 1 small bowel, 1 esophagus); 8) 3 hemorrhages from spleen with blood loss over 1300 ml required conversion (1 spleen removed, 6 minor not requiring open conversion); 9) 3 conversions were for anomaly/disease (1 malrotation of colon, 1 ovarian teratoma, and 1 intra-thoracic stomach).


CONCLUSIONS
Steatohepatitis, diabetes mellitus, adhesions from various causes, previous bile leaks, large waist size, BMI, and weight are predictors for conversion to open surgery.
Schwartz
Michael L
ML
Department of Surgery, Abbott Northwestern Hospital, 920 East 20th Street, Minneapolis, MN 55407, USA. Michael.Schwartz@comcast.net
Drew
Raymond L
RL
Chazin-Caldie
Marilyn
M
D000328:Adult; D000713:Anastomosis, Roux-en-Y; D005260:Female; D015390:Gastric Bypass / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy; D008297:Male; D012307:Risk Factors; D017211:Treatment Failure