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

Obes Surg. 2009 Oct;19(10):1355-64. doi: 10.1007/s11695-009-9933-4. Epub 2009 Aug 15.

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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Body Mass Index
  • Clinical Competence
  • Female
  • Gastric Bypass* / instrumentation
  • Gastric Bypass* / methods
  • Gastric Bypass* / standards
  • Gastrointestinal Hemorrhage / epidemiology
  • Gastrointestinal Hemorrhage / mortality
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Obesity, Morbid / mortality*
  • Obesity, Morbid / surgery*
  • Postoperative Complications / epidemiology
  • Postoperative Complications / mortality
  • Postoperative Period
  • Retrospective Studies
  • Surgical Stapling / methods
  • Surgical Stapling / standards*
  • Treatment Outcome
  • Young Adult