Evolution of minimally invasive bariatric surgery. Surgery 2002 Oct;132(4):565-71; discussion 571-2
Date
10/31/2002Pubmed ID
12407339DOI
10.1067/msy.2002.127554Scopus ID
2-s2.0-0036774502 (requires institutional sign-in at Scopus site) 48 CitationsAbstract
BACKGROUND: Minimally invasive Roux-en-Y gastric bypass is a procedure that is being performed with increasing frequency. It is an advanced laparoscopic procedure with a steep learning curve. With experience, it can be performed in a reasonable amount of time with minimal morbidity.
METHODS: We first performed minimally invasive gastric bypass with the hand-assisted laparoscopic surgery (HALS) technique. After significant experience with HALS, we changed our approach to completely laparoscopic (LS). Our technique for all cases involves a circular stapled gastrojejunostomy with a 25-mm anvil passed transgastrically.
RESULTS: From June 1998 to January 2002, 304 patients underwent minimally invasive gastric bypass. Our first 81 cases were with HALS, and the rest were LS. The incidence of early major and minor perioperative complications for the entire series was 5.6% and 7.9%, respectively. Early reoperation (less than 30 days) was required in 4.6% of all patients. There was 1 leak (1.2%) in the HALS group and 4 anastomotic leaks (1.8%) in the LS group. Other measured outcomes were similar in each group with the exception of wound hernia (16% HALS vs 0.9% LS). Weight loss after 1 year was 44% for HALS and 56% for LS. We have not had any deaths in our series.
CONCLUSIONS: HALS may have certain advantages in selected patients and early in a surgeon's experience with minimally invasive gastric bypass. With experience, good results are possible with either approach.
Author List
Gould JC, Needleman BJ, Ellison EC, Muscarella P, Schneider C, Melvin WSAuthor
Jon Gould MD Chief, Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAnastomosis, Roux-en-Y
Gastric Bypass
Humans
Laparoscopy
Length of Stay
Middle Aged
Minimally Invasive Surgical Procedures
Postoperative Complications
Reoperation
Retrospective Studies
