title: Complications After Laparoscopic Roux-en-Y Gastric Bypass in 1573 Consecutive Patients: Are There Predictors?
abstract: BACKGROUND
  Roux-en-Y gastric bypass (RYGBP), one of the commonest performed bariatric procedures, remains a technically challenging operation associated with significant morbidity in high-risk patients. This study was conducted in order to identify predictors of complications after laparoscopic RYGBP.
  
  
  METHODS
  Our prospectively established database has been assessed to review 30-day and in-hospital complications graded according to a validated scoring system (Clavien-Dindo) and separated into minor (Clavien-Dindo I-IIIa) and major (Clavien-Dindo IIIb-IV) complications. Patient- and procedure-related factors were analyzed using univariate analysis. Significant factors associated with morbidity were introduced into a multivariate analysis to identify independent predictors.
  
  
  RESULTS
  Between 1999 and 2012, 1573 patients underwent laparoscopic RYGBP, 374 male and 1199 female. Mean age was 41 years, and mean body mass index (BMI) was 44.5 kg/m(2). One hundred fifty-nine procedures were reoperations. One hundred fifty (9.5 %) patients developed at least one complication, and 43 (2.7 %) had major complications, leading to death in one case (0.06 %). Risk factors for morbidity were male gender (p = 0.006) and overall experience of the team (p < 0.0001). Prolonged 3-day antibiotic therapy was associated with significantly reduced overall (p < 0.0001) and major (p = 0.005) complication rates. Major complications were associated with smoking (p = 0.016).
  
  
  CONCLUSIONS
  The most significant individual risk factors for early complications after RYGBP are male gender, limited surgical experience, and single dose of antibiotics. RYGBP should be performed by experienced teams. Smoking should be discontinued before surgery. Prolonged antibiotic therapy could be considered, especially if a circular stapled gastrojejunostomy is performed with the anvil introduced transorally.
authors.affiliation: Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.|Department of Surgery, Hôpital Riviera-Chablais (HDC), 1860, Aigle-Monthey, Switzerland.
authors.forename: Anna
authors.initials: A
authors.lastname: Dayer-Jankechova
authors.affiliation: Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Fournier
authors.affiliation: Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Allemann
authors.affiliation: Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland. michelsuter@netplus.ch.|Department of Surgery, Hôpital Riviera-Chablais (HDC), 1860, Aigle-Monthey, Switzerland. michelsuter@netplus.ch.
authors.forename: Michel
authors.initials: M
authors.lastname: Suter
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D019990:Perioperative Care / Q000379:methods; D012086:Reoperation / Q000009:adverse effects / Q000379:methods; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Complications; Laparoscopy; Morbid obesity; Risk factors; Roux-en-Y gastric bypass