Laparoscopic Gastric Bypass

Excerpt

Gastric Bypass is a common operation for weight loss in patients with severe obesity. The procedure was developed in the 1960s by Drs. Mason and Ito who observed significant weight loss in a patient undergoing partial gastrectomy for peptic ulcer disease. This surgery was traditionally done with the open approach, and as with any open surgery, there were incidences as high as 20% of an incisional hernia and wound complications as high as 8%. This led to the advent of the laparoscopic approach to improve postoperative outcomes in bariatric patients. The first case series of laparoscopic Roux-en-Y gastric bypass (RYGB) was presented in 1994 by Drs. Wittgrove and Clark, and the largest trial was reported by Nguyen and colleagues in 2001. Much data has proven that the laparoscopic approach to RYGB results in decreases in hospital stay, intraoperative blood loss, postoperative pain, pulmonary complications, and wound infections. Studies have shown a steep learning curve for the laparoscopic gastric bypass, and a possible increased rate of postoperative internal hernia (a surgical emergency.) Despite this, it is now considered safer and more cost-effective than traditional, open RYGB.

Today over 90% of gastric bypasses performed for weight loss are done laparoscopically. Despite being one of the most challenging, minimally invasive operations, it has become the most common foregut surgery performed in the United States. Of the many ways to perform this surgery, the fundamentals of each technique remain the same.