title: Laparoscopic Roux en-Y Gastric Bypass Using a Modified Retrocolic-Supracolic Approach: Outcomes from 300 Patients.
abstract: Laparoscopic Roux en-Y gastric bypass (LRYGB) achieves sustained long-term weight loss and reduced mortality in morbidly obese patients. It is routinely performed using an ante- or retrocolic approach with the jejuno-jejunostomy constructed in the infracolic compartment. We have modified the standard technique of performing LRYGB by constructing both anastomoses in the supracolic compartment. This study describes the outcomes of consecutive primary LRYGB performed using this novel retrocolic-supracolic approach.
  
  
  
  Data were prospectively collected on consecutive primary LRYGB performed in a tertiary-referral Bariatric Centre in the United Kingdom from September 2009 to March 2013. Data included demographics, operative outcomes (duration of surgery, postoperative anastomotic leak/bleeding/reoperations), development of strictures, length of stay, excess weight loss (EWL) and resolution of diabetes mellitus.
  
  
  
  Hand-sewn LRYGB was successfully performed using the retrocolic-supracolic approach in 300 of 307 (98 %) consecutive patients (72 % female). Median (IQR) age, weight and baseline body mass index were 49 (41-56) years, 146 (134-163) kg and 52.9 (48.8-57.2) kg/m(2), respectively. There were 4 (1.3 %) anastomotic leaks and 8 (2.6 %) postoperative bleeds. The 30-day reoperation rate was 1.6 %. Median (IQR) hospital stay was 2 (2-2) days. Postoperative dysphagia requiring endoscopic balloon dilatation occurred in 19 (6.3 %) patients. Mean ± SD 12-month EWL was 69.9 ± 19.0 %. Within the follow-up period, 81 % of patients with type II diabetes mellitus achieved remission and 19 % reduced dosage of diabetes medication.
  
  
  
  LRYGB performed using the retrocolic-supracolic approach was safe, feasible, technically advantageous and resulted in clinical outcomes akin to the standard infracolic approach.
authors.affiliation: The East-Midlands Bariatric & Metabolic Institute (EMBMI), Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK.
authors.forename: Waleed
authors.initials: W
authors.lastname: Al-Khyatt
authors.affiliation: The East-Midlands Bariatric & Metabolic Institute (EMBMI), Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Bull
authors.affiliation: The East-Midlands Bariatric & Metabolic Institute (EMBMI), Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK. sherif.awad@nhs.net.
authors.forename: Sherif
authors.initials: S
authors.lastname: Awad
authors.affiliation: The East-Midlands Bariatric & Metabolic Institute (EMBMI), Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK.
authors.forename: Javed
authors.initials: J
authors.lastname: Ahmed
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects / Q000379:methods*; D057868:Anastomotic Leak / Q000209:etiology; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D004106:Dilatation; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007583:Jejunum / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000209:etiology*; D012086:Reoperation; D015431:Weight Loss