title: Laparoscopic bariatric surgery can be performed safely in the community hospital setting.
abstract: BACKGROUND
  Bariatric surgery is being performed commonly in various practice settings. To evaluate safety and efficacy, we reviewed the results of our first 516 laparoscopic bariatric operations performed in a community hospital setting.
  
  
  METHODS
  We reviewed retrospectively the results of our first 516 consecutive laparoscopic bariatric procedures.
  
  
  RESULTS
  Between December 2001 and December 2004, we performed 516 bariatric surgical procedures. Ninety-nine percent of these were accomplished laparoscopically. Thirty-day mortality in our series of 516 patients is 0%. Of these patients, 431 had laparoscopic gastric bypass. The mean BMI in these patients was 51. Mean percent excess weight loss in the laparoscopic gastric bypass patients was 70% at 1 year, 79% at 2 years and 84% at 3 years. Complications in the laparoscopic bypass group requiring reoperation included 11 bowel obstructions (2.5%), 5 episodes of bleeding (1.1%), and 2 laparoscopies for benign reasons. There were 8 anastomotic leaks (1.9%)-7 requiring reoperation, 1 managed nonoperatively. Eighty-five patients had adjustable gastric banding. Mean BMI was 45. Mean percent excess weight loss in the adjustable gastric banding patients was 39% at 1 year and 57% at 2 years. Complications in the adjustable gastric band patients requiring reoperation included 3 access port malfunctions (3.5%), 3 prolapsed bands (3.5%), 1 punctured band requiring replacement (1.2%) and 1 band causing complete obstruction requiring removal (1.2%).
  
  
  CONCLUSIONS
  Laparoscopic bariatric surgery can be performed safely in the community hospital setting with a very low operative morbidity and mortality. This requires an experienced team of bariatric surgeons leading a multidisciplinary team of other health care professionals. Surgeon experience and super obesity can influence the risks.
authors.affiliation: Bariatric Institute of Wisconsin, Waukesha, WI 53188, USA.
authors.forename: James W
authors.initials: JW
authors.lastname: Burhop
authors.forename: Manfred C
authors.initials: MC
authors.lastname: Chiang
authors.forename: David J
authors.initials: DJ
authors.lastname: Engstrand
authors.forename: Megan
authors.initials: M
authors.lastname: O'Driscoll
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006764:Hospitals, Community; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014922:Wisconsin