title: Excellent laparoscopic gastric bypass outcomes can be achieved at a community-based training hospital with moderate case volume.
abstract: OBJECTIVE
  Our objective was to assess laparoscopic gastric bypass outcomes in a moderate case volume setting.
  
  
  BACKGROUND
  Laparoscopic gastric bypass remains one of the most advanced laparoscopic procedures currently performed worldwide. The following represents a single institutional series from a community hospital-based training program with a minimally invasive bariatric surgical program.
  
  
  METHODS
  Data from all patients undergoing laparoscopic gastric bypass since the inception of the program were entered into a prospective database. Measured outcomes included length of operation, length of stay, major and minor complications, and percentage excess weight loss. Results were compared with published outcomes from a review of the literature encompassing more than 3400 cases using chi and Fisher exact tests.
  
  
  RESULTS
  Between September 2001 and October 2008, 700 consecutive patients underwent laparoscopic gastric bypass. The mean age was 43.1 +/- 9.5 years, and 83% were female. The mean initial weight was 135.5 +/- 22.4 kg. The initial body mass index was 47.9 +/- 6 kg/m. The mean length of stay was 2.2 +/- 0.9 days. The length of operation was 147.8 +/- 31.8 minutes. The mean percent excess weight loss at 1-year postoperative was 72.4%. There were no mortalities. Compared with the literature, we achieved a lower rate of anastomotic leak (0.3% vs. 2%, P = 0.001) and stomal stenosis (1% vs. 4.7%, P = 0.001).
  
  
  CONCLUSIONS
  Excellent outcomes following laparoscopic gastric bypass can be achieved in a community hospital-based program with moderate case volume. Reimbursement decisions should take into consideration a program's actual outcomes rather than volume.
authors.affiliation: Department of Surgery, Gundersen Lutheran Health System, La Crosse, WI 54601, USA. snkothar@gundluth.org
authors.forename: Shanu N
authors.initials: SN
authors.lastname: Kothari
authors.forename: Kara J
authors.initials: KJ
authors.lastname: Kallies
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Mathiason
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Baker
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006764:Hospitals, Community; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome; D014922:Wisconsin; D016526:Workload