title: Non-transectional open gastric bypass as the definitive bariatric procedure for 61 patients with BMI of 70 and higher.
abstract: BACKGROUND
  Technical difficulties in laparoscopic gastric bypass for severely obese patients have led to sleeve gastrectomy first and then laparoscopic gastric bypass as a second stage after significant weight loss. Rather than commit these fragile patients to two operations, we have done open gastric bypass as a definitive surgical treatment for extreme obesity.
  
  
  METHODS
  Office records of 61 patients with body mass index (BMI) of 70 and higher were reviewed. All underwent non-transectional open gastric bypass with a 150 cm Roux limb. Data included age, sex, weight, BMI, co-morbidities, operative information, length of stay (LOS), surgical morbidity, and percent excess weight loss (%XSWL). Data are in median (range).
  
  
  RESULTS
  There were 21 (34%) men and 40 (66%) women: age, 37 years (19-53); pre-operative weight, 468 lb (300-650); and pre-operative BMI, 77 (70-95). Co-morbidities were diabetes mellitus, 26 (46%); hypertension, 26 (43%); sleep apnea, 61 (100%); gastroesophageal reflux disease, 20 (33%); and hypothyroid nine (15%). Incision length was 15 cm (12-20), abdominal wall fat thickness was 8 cm (5-13), operative time was 150 min (100-210), and estimated blood loss was 100 ml (25-750); post-op intensive care unit: yes 16 (26%) and no 44 (74%). LOS was 3 days for 44 patients (74%), 4 days for 11 (18%), 5 days for five (8%), and 7 days for one (1.6%). Post-operative morbidity was as follows: zero mortality, splenectomy, stoma leak, deep venous thrombosis, pulmonary embolus, GI bleeding, stomal ulcer, intestinal obstruction, fascial dehiscence, or 30-day readmission; wound infections in one (1.6%); skin wound separation in six (10%); pneumonia in one (1.6%); anemia in nine (14.8%); vitamin B(12) deficiency in six (10%); incisional hernia in 17 (28%); and gastric staple line disruption in two (3.3%). %XSWL were 51% in 1 year (28-84) and 60% in 2 years (27-97).
  
  
  CONCLUSIONS
  Non-transectional open gastric bypass for patients with BMI of 70 and higher is safe and effective as a one-stage operation for severe obesity.
authors.affiliation: Department of Surgery, UMDNJ, Camden, NJ, USA. doctorg49@aol.com
authors.forename: Gus J
authors.initials: GJ
authors.lastname: Slotman
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007037:Hypothyroidism / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D012891:Sleep Apnea Syndromes / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000517:prevention & control*; D055815:Young Adult