title: Simplified fast-track laparoscopic Roux-en-Y gastric bypass.
abstract: BACKGROUND
  The surgical management of complex or morbid obesity is increasing exponentially. Laparoscopic procedures are being increasingly utilized due to their similar efficacy but shorter hospital stay and faster convalescence when compared with open surgery. Despite this, many patients remain in hospital for a number of days after laparoscopic obesity surgery due to concerns about potential sequelae. We present the results of our simplified fast-track service, designed to enable discharge of all patients on postoperative day one following laparoscopic Roux-en-Y gastric bypass (LRYGB).
  
  
  METHODS
  All patients operated on by a single surgeon during a 3-year period underwent fast-track management and were included. Our simplified fast-track service has three components; it is applicable to all patients, patients are counselled regarding fast-track discharge and the only routine postoperative investigations are full blood count and serum C-reactive protein (CRP). CRP was investigated as a prognosticator for complications following LRYGB.
  
  
  RESULTS
  One hundred twelve patients underwent a LRYGB during the study period (35 male, median age 44 [18-73], median BMI 49.4 [36.5-75.0]). Ninety-eight patients (87.5 %) were discharged the day after LRYGB. Five patients developed postoperative complications (three major, two minor). One patient required readmission following discharge on postoperative day 1. A CRP greater than 100 mg/L on postoperative day 1 was found to predict major complications with 100 % sensitivity and 95 % specificity with a diagnostic accuracy of 0.98.
  
  
  CONCLUSIONS
  Our simplified fast-track LRYGB service allows the vast majority of patients to be safely and successfully discharged on postoperative day 1.
authors.affiliation: Department of HPB and Transplant Surgery, St James's University Hospital, Leeds, LS9 7TF, UK, twpike@doctors.org.uk.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Pike
authors.forename: Alan D
authors.initials: AD
authors.lastname: White
authors.forename: Niki J
authors.initials: NJ
authors.lastname: Snook
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Dean
authors.forename: J Peter A
authors.initials: JP
authors.lastname: Lodge
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D019468:Disease Management; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood / Q000601:surgery*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000097:blood; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D002097:C-Reactive Protein