title: Standardization of the fully stapled laparoscopic Roux-en-Y gastric bypass for obesity reduces early immediate postoperative morbidity and mortality: a single center study on 2606 patients.
abstract: BACKGROUND
  Various techniques of laparoscopic Roux-en-Y gastric bypass have been described. We completely standardized this procedure to minimize its sometimes substantial morbidity and mortality. This study describes our experience with the standardized fully stapled laparoscopic Roux-en-Y gastric bypass (FS-LRYGB) and its influence on the 30-day morbidity and mortality.
  
  
  METHODS
  We retrospectively analyzed 2,645 patients who underwent FS-LRYGB from May 2004 to August 2008. Operative time, hospital stay and readmission, re-operation, and 30-day morbidity/mortality rates were then calculated. The 30-day follow-up data were complete for 2,606 patients (98.5%).
  
  
  RESULTS
  There were 539 male and 2,067 female patients. Mean age was 39.2 years (range 14-73), mean BMI 41.44 kg/m(2) (range, 23-75.5). The mean hospital stay was 3.35 days (range 2-71). Mean total operative time was 63 min (range 35-150). One patient died of pneumonia within 30 days of surgery (0.04%). One hundred and fifty one (5.8%) patients had postoperative complications as follows: gastrointestinal hemorrhage (n = 89, 3.42%), intestinal obstruction (n = 9, 0.35%), anastomotic leak (n = 5, 0.19%) and others (n = 47, 1.80%). In 66 patients, the bleeding resolved without any surgical re-intervention. One hemorrhage resulted in hypovolemic shock with subsequent renal and hepatic failure.
  
  
  CONCLUSIONS
  The systematic approach and the full standardization of the FS-LRYGB procedure contribute highly to the very low mortality and the low morbidity rates in our institution. Gastrointestinal bleeding appears to be the commonest complication, but is self-limiting in the majority of cases. Our approach also significantly reduces operative time and turns the technically demanding laparoscopic Roux-en-Y gastric bypass procedure into an easy reproducible operation, effective for training.
authors.affiliation: Department of General Surgery, AZ Sint-Jan Hospital AV, Bruges, Belgium. bruno.dillemans@azbrugge.be
authors.forename: Bruno
authors.initials: B
authors.lastname: Dillemans
authors.forename: Nasser
authors.initials: N
authors.lastname: Sakran
authors.forename: Sebastiaan
authors.initials: S
authors.lastname: Van Cauwenberge
authors.forename: Thibault
authors.initials: T
authors.lastname: Sablon
authors.forename: Barbara
authors.initials: B
authors.lastname: Defoort
authors.forename: Els
authors.initials: E
authors.lastname: Van Dessel
authors.forename: Faki
authors.initials: F
authors.lastname: Akin
authors.forename: Nathalie
authors.initials: N
authors.lastname: Moreels
authors.forename: Sebastiaan
authors.initials: S
authors.lastname: Lambert
authors.forename: Jan
authors.initials: J
authors.lastname: Mulier
authors.forename: Ravindra
authors.initials: R
authors.lastname: Date
authors.forename: Michel
authors.initials: M
authors.lastname: Vandelanotte
authors.forename: Tom
authors.initials: T
authors.lastname: Feryn
authors.forename: Luc
authors.initials: L
authors.lastname: Proot
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002983:Clinical Competence; D005260:Female; D015390:Gastric Bypass / Q000295:instrumentation / Q000379:methods / Q000592:standards; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000401:mortality* / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D011184:Postoperative Period; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000379:methods / Q000592:standards*; D016896:Treatment Outcome; D055815:Young Adult
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