Faculty Collaboration Database

Lessons learned from the first 100 cases in a new minimally invasive bariatric surgery program. Obes Surg 2004 May;14(5):618-25

Date

06/10/2004

Pubmed ID

15186628

DOI

10.1381/096089204323093381

Scopus ID

2-s2.0-2642576097 (requires institutional sign-in at Scopus site)   71 Citations

Abstract

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is a technically demanding procedure with a steep learning curve. Experienced laparoscopic surgeons and bariatric surgeons can learn from the outcomes and complications of their initial experience in LRYGBP.

METHODS: Between August of 2002 and July of 2003, we performed our first 100 LRYGBPs. Our surgical technique involves the ante-colic, ante-gastric placement of the Roux-limb. A 21-mm circular stapler is used to create the gastrojejunostomy. The stapler anvil is placed transgastrically.

RESULTS: The mean preoperative BMI was 49.7 kg/m(2) (range 37-70). 12% of patients were male. Early complications (14%) included 3 leaks, 4 bleeding episodes and 2 gastrogastric fistulas. There was 1 peri-operative mortality and 1 conversion to laparotomy. Late complications (17%) included stenosis of the gastrojejunostomy which occurred in 14 patients. Leaks occurred more commonly in males (16% vs 1%, P<0.05). Elevated BMI was also found to be a risk factor for leak (BMI 58.7 leak vs 49.3 no leak, P<0.05). Stenosis was often associated with other complications such as leak or marginal ulcer. Stenosis responded well to endoscopic dilation. Co-morbid medical conditions responded to weight loss in all patients, regardless of initial BMI. Mean excess weight loss was 69% at 1 year, but varied according to preoperative BMI.

CONCLUSIONS: Careful recording of patient outcomes and complications is important, particularly in a new minimally invasive bariatric surgery program. Review and analysis of specific complications may help to minimize the occurrence of similar subsequent complications.

Author List

Gould JC, Garren MJ, Starling JR

Author

Jon Gould MD Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Body Constitution
Female
Gastric Bypass
Gastric Fistula
Humans
Laparoscopy
Male
Middle Aged
Surgical Stapling
Suture Techniques