title: Four hundred fifty consecutive laparoscopic Roux-en-Y gastric bypasses with no mortality and declining leak rates and lengths of stay in a bariatric training program.
abstract: BACKGROUND
  We reviewed our obesity surgery database for 2 experienced bariatric surgeons since their last patient death in October 2003 through July 2007.
  
  
  METHODS
  Data on all patients undergoing planned laparoscopic Roux-en-Y gastric bypass (L-GBP) by the two attending bariatric surgeons at the Medical College of Virginia Hospitals were reviewed. The operations were performed by fellows in minimally invasive surgery, assisted by the 2 attending physicians in more than 90% of patients. Surgical technique included a handsewn imbrication of a gastrojejejunostomy and jejunojejunostomy, each performed with a linear stapler. Routine sampling of a juxtaanastamotic drain for amylase levels was substituted for routine upper gastrointestinal contrast studies during the study period.
  
  
  RESULTS
  All patients, except those who had earlier extensive upper abdominal surgery in that time period, were offered a laparoscopic approach (5.7% were converted to open procedures). The mean (+/- SD) age was 42.4+/-11 years; body mass index was 49.5+/-9 kg/m(2). Women represented 80.5% of patients. The leak rate declined from 9.7% in 2004 to 2.0% in 2006 (p < 0.05, chi-square test); there have been no leaks in any patient since July 2006, including the 40 patients in 2007. Hospital length of stay declined from 4.7+/-5.7 days in 2004 to 2.9+/-3.3 days in 2006 (p < 0.05, Wilcoxon rank test). At 1-year followup, 270 patients had lost 66.1%+/-17% of initial excess weight, which was similar to that in our open gastric bypasses. Comorbid conditions improved or resolved in 67.6% of patients with diabetes, 56.1% of those with hypertension, 75% of those with sleep apnea, 87.8% of those with urinary stress incontinence, 95.9% of those with gastroesophageal reflux disease, and in 100% of those with stasis ulcers. Overall complication rates of wound infection (1.5%), incisional hernia (1.7%), internal hernia (0.2%), and intestinal obstruction (1.7%) were low.
  
  
  CONCLUSIONS
  Results for laparoscopic Roux-en-Y gastric bypass improve with experience and can be taught in an academic training program, with low morbidity and mortality. Routine postoperative upper gastrointestinal contrast studies are unnecessary and may lengthen hospital stay.
authors.affiliation: Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
authors.forename: James W
authors.initials: JW
authors.lastname: Maher
authors.forename: Lisa
authors.initials: L
authors.lastname: Martin Hawver
authors.forename: Anthony
authors.initials: A
authors.lastname: Pucci
authors.forename: Luke G
authors.initials: LG
authors.lastname: Wolfe
authors.forename: Jill G
authors.initials: JG
authors.lastname: Meador
authors.forename: John M
authors.initials: JM
authors.lastname: Kellum
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects; D050110:Bariatric Surgery / Q000193:education*; D004493:Education / Q000706:statistics & numerical data*; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000401:mortality / Q000706:statistics & numerical data*; D006801:Humans; D007583:Jejunum / Q000601:surgery; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D013270:Stomach / Q000601:surgery; D013529:Surgical Wound Dehiscence / Q000453:epidemiology / Q000209:etiology; D013536:Suture Techniques / Q000009:adverse effects