Laparoscopic Roux-en-Y gastric bypass: results and learning curve of a high-volume academic program

Arch Surg. 2005 Apr;140(4):362-7. doi: 10.1001/archsurg.140.4.362.


Hypothesis: Laparoscopic Roux-en-Y gastric bypass is a complex procedure performed on a high-risk patient population. Good results can be attained with experience and volume.

Design: Retrospective study.

Setting: Tertiary care academic hospital.

Patients: Seven hundred fifty consecutive morbidly obese patients undergoing surgery from March 1998 to April 2004.

Interventions: All patients underwent laparoscopic Roux-en-Y gastric bypass.

Main outcome measures: Perioperative deaths and complications.

Results: The patient population was 85% women and had a mean body mass index of 47 kg/m2 (range, 32-86 kg/m2). The overall complication rate was 15% and the mortality was 0.3%. For the first 100 cases, the overall complication rate was 26% with a mortality of 1%. This complication rate decreased to approximately 13% and was stable for the next 650 patients. The incidence of major complications has also decreased since the first 100 cases. Leak decreased from 3% to 1.1%. Small-bowel obstruction decreased from 5% to 1.1%. Overall mean operating time was 138 minutes (range, 65-310 minutes). It decreased from 212 minutes for the first 100 cases to 132 minutes for the next 650 and 105 minutes (range, 65-200 minutes) for the last 100 cases.

Conclusions: Laparoscopic Roux-en-Y gastric bypass is a technically difficult operation. This review of a large series in a high-volume program demonstrated that the morbidity and mortality could be reduced by 50% with experience. The results are similar to those reported from other major centers. In addition, as reported elsewhere, the learning curve for this procedure may be 100 cases.

MeSH terms

  • Academic Medical Centers
  • Adolescent
  • Adult
  • Aged
  • Anastomosis, Roux-en-Y*
  • Clinical Competence
  • Female
  • Gastric Bypass / methods*
  • Gastric Bypass / mortality
  • Humans
  • Laparoscopy*
  • Middle Aged
  • Obesity, Morbid / surgery*
  • Postoperative Complications
  • Quality of Health Care
  • Retrospective Studies
  • Treatment Outcome