title: Simplified gastric bypass: 13 years of experience and 12,000 patients operated.
abstract: BACKGROUND
  Obesity is increasingly prevalent disease worldwide and bariatric surgery is the most effective treatment for the most severe cases. The Roux-en-Y gastric bypass is still the most used technique all over the world and the laparoscopic approach has been preferred by surgeons with different approaches, propositions and techniques in performing the procedure.
  
  
  OBJECTIVE
  To report the surgical aspects of the systematization and results of the simplified laparoscopic gastric bypass (Brazilian technique).
  
  
  METHODS
  Were included all patients undergoing this procedure from January 2001 to July 2014; were described and analyzed aspects of this technique, the systematization and complications associated with the procedure.
  
  
  RESULTS
  A total of 12,000 patients (72% women) were included, with a mean age of 43 years (14-76) and a mean BMI of 44.5 (35-90 kg/m2). Mean total operative time was 72 minutes (36-270) and the mean hospital stay was 36 hours. There were 303 cases of gastrojejunostomy stenosis (2.5%), 370 patients had gastrointestinal bleeding (3%) with only one lap revision due to a enteroanastomosis bleeding and six revisions related to intestinal obstruction caused by impacted clots in the jejunojenunostomy. Blood transfusion was needed in 32 patients (0.3%); Petersen hernia was diagnosed in 18 (0.15%) and digestive fistula in 54 (0.45%), which led to reoperation in 43 of them (67%). The overall mortality was 0.1% (fistula with sepsis=8, pulmonary thromboembolism=3; intestinal obstruction associated with sepsis=1).
  
  
  CONCLUSIONS
  The simplified laparoscopic gastric bypass is a feasible and safe option with low complication rate and easy reproducibility for education and training in bariatric surgery.
authors.affiliation: Institute Gastro-Obeso-Center, São Paulo, SP, Brazil.
authors.forename: Almino Cardoso
authors.initials: AC
authors.lastname: Ramos
authors.affiliation: Institute Gastro-Obeso-Center, São Paulo, SP, Brazil.
authors.forename: Andrey Carlo Sousa
authors.initials: AC
authors.lastname: Silva
authors.affiliation: Institute Gastro-Obeso-Center, São Paulo, SP, Brazil.
authors.forename: Manoela Galvão
authors.initials: MG
authors.lastname: Ramos
authors.affiliation: Institute Gastro-Obeso-Center, São Paulo, SP, Brazil.
authors.forename: Edwin Gonzalo Claros
authors.initials: EG
authors.lastname: Canseco
authors.affiliation: Institute Gastro-Obeso-Center, São Paulo, SP, Brazil.
authors.forename: Manoel dos Passos
authors.initials: Mdos P
authors.lastname: Galvão-Neto
authors.affiliation: Institute Gastro-Obeso-Center, São Paulo, SP, Brazil.
authors.forename: Mariano de Almeida
authors.initials: Mde A
authors.lastname: Menezes
authors.affiliation: Institute Gastro-Obeso-Center, São Paulo, SP, Brazil.
authors.forename: Thales Delmondes
authors.initials: TD
authors.lastname: Galvão
authors.affiliation: Institute Gastro-Obeso-Center, São Paulo, SP, Brazil.
authors.forename: Eduardo Lemos de Souza
authors.initials: EL
authors.lastname: Bastos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D013997:Time Factors; D055815:Young Adult