Standardization of the Fully Stapled Laparoscopic Roux-en-Y Gastric Bypass for Obesity Reduces Early Immediate Postoperative Morbidity and Mortality: A Single Center Study on 2606 Patients

Abstract

Background Various techniques of laparoscopic Roux-en-Y gastric bypass have been described. We completely standardized this procedure to minimize its sometimes substantial morbidity and mortality. This study describes our experience with the standardized fully stapled laparoscopic Roux-en-Y gastric bypass (FS-LRYGB) and its influence on the 30-day morbidity and mortality.Methods We retrospectively analyzed 2,645 patients who underwent FS-LRYGB from May 2004 to August 2008. Operative time, hospital stay and readmission, re-operation, and 30-day morbidity/mortality rates were then calculated. The 30-day follow-up data were complete for 2,606 patients (98.5%). Results There were 539 male and 2,067 female patients. Mean age was 39.2 years (range 14-73), mean BMI 41.44 kg/m 2 (range, 23-75.5). The mean hospital stay was 3.35 days (range 2-71). Mean total operative time was 63 min (range 35-150).One patient died of pneumonia within 30 days of surgery (0.04%). One hundred and fifty one (5.8%) patients had postoperative complications as follows: gastrointestinal hemorrhage (n=89, 3.42%), intestinal obstruction (n=9, 0.35%), anastomotic leak (n=5, 0.19%) and others (n=47, 1.80%). In 66 patients, the bleeding resolved without any surgical re-intervention. One hemorrhage resulted in hypovolemic shock with subsequent renal and hepatic failure. Conclusion The systematic approach and the full standardization of the FS-LRYGB procedure contribute highly to the very low mortality and the low morbidity rates in our institution. Gastrointestinal bleeding appears to be the commonest complication, but is self-limiting in the majority of cases. Our approach also significantly reduces operative time and turns the technically demanding laparoscopic Roux-en-Y gastric bypass procedure into an easy reproducible operation, effective for training.

High-Volume Bariatric Surgery in a Single Center: Safety, Quality, Cost-Efficacy and Teaching Aspects in 2,000 Consecutive Cases

“…We had 56 (2.8%) early complications occurring in 48 patients, including ten anastomotic leakages (0.50%). Our early complication rate is acceptable and comparable with good results from other high-volume units [14,[19][20][21]. Our re-operation rate was 1.3%, but some of the leaks and bleedings could probably have been treated conservatively.…”

“…Patient demographics in our study are comparable with other European series on gastric bypass [14,19,20] regarding BMI and co-morbidities. We had a high followup rate (98.6%) on weight loss and early and serious complications.…”

Improved Surgical Technique for Laparoscopic Roux-en-Y Gastric Bypass Reduces Complications at the Gastrojejunostomy

“…They develop within the first few days after surgery and can sometimes be devastating if not treated promptly and aggressively, although they may be completely asymptomatic. Marginal In the literature, the incidence of leaks at the GJS after RYGBP varies between extremes of 0% and more than 8%, but usually between 1% and 3% and is reported to depend, among others, on the experience of the surgeon, the surgical approach, the technique of anastomosis (hand sewn versus circular versus linear stapled) and the fact that RYGBP is performed as a primary or re-do procedure [1][2][3][4][5][6][7][8][9][10][11]. Several authors have suggested technical adjuncts to reduce the incidence of leaks, such as reinforcement of the staple line [27], or use of fibrin sealant [28].…”

The role of upper gastrointestinal endoscopy in treating postoperative complications in bariatric surgery

“…[26][27][28][29][30][31] The timing and extent of postoperative hemorrhage following RYGB and associated clinical symptoms aid in determining management. Overt bleeding and a decline in hematocrit within the first 6 hours post-surgery is an indication that intervention may be required.…”