title: Fast-track laparoscopic gastric bypass surgery: outcomes and lessons from a bariatric surgery service in the United Kingdom.
abstract: BACKGROUND
  Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a potentially complicated surgery with significant hospitalisation, especially during the learning curve. There are inadequate data on fast-track LRYGB in relation to learning curve. This study highlights the outcomes of a fast-track LRYGB service.
  
  
  METHODS
  This observational study examined the perioperative outcome data of 406 consecutive LRYGB patients over a 4-year period. Perioperative outcome data were analysed and compared between severe obesity, morbid obesity and super obesity groups.
  
  
  RESULTS
  Mean BMI was 48.6 ± 8.3, mean age was 42 years and male to female ratio was 1:4. About 4% of patients had concurrent ventral hernia repair. Median duration of combined LRYGB and ventral hernia repair was 115 min, compared to 95 min for LRYGB alone (p = 0.09). Intraoperative complication rate was 0.5%. Postoperative complications occurred in 3.4% of patients with 60% within 24 h. The complication rate per obesity group was <7% and similar between groups (p = 0.4). There was no perioperative mortality. More super obese patients received postoperative intensive care compared to others (p = 0.001). Mean length of hospital stay was similar between obesity groups and decreased from 2 to 1 day over 2 years. There was a learning curve of 109 cases over 2 years.
  
  
  CONCLUSIONS
  LRYGB is a safe technique of bariatric surgery with low risk of perioperative complications. Establishing a fast-track LRYGB service requires a learning curve of 100 cases, and a good indicator is length of hospital stay, which decreases as the service matures. Most LRYGB patients can be safely discharged by 24 h.
authors: Department of Anaesthesia, Central Manchester University Hospital, Oxford Road, Manchester, M13 9WL, UK. mubitim@yahoo.co.uk
authors: Olumuyiwa A
authors: OA
authors: Bamgbade
authors: Babatunji O
authors: BO
authors: Adeogun
authors: Kamran
authors: K
authors: Abbas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data; D059032:Learning Curve; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology / Q000601:surgery*; D009767:Obesity, Morbid / Q000601:surgery; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology* / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult