1. Laparoscopic roux-en-y gastric bypass: Single centre experience of 420 cases
Wilson MSJ, Alhamdani A, Mahawar K, Boyle M*, Schroeder N, Balupuri S, Small PK
Departments of General Surgery and Dietetics*,
Sunderland Royal Hospital, Kayll Road, Sunderland, SR4 7TP, UK.
Aims
We have performed 420 Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) between January 2005 and February This study aims to evaluate our experience to date with this procedure.
Methods
Data was analysed from a prospectively maintained database. Study end points included; operating time, postoperative hospital stay, early (<30 days) and late (>30 days) readmissions and complications and mean percentage excess weight loss.
Results
420 patients were scheduled for LRYGB. Another 6 underwent open surgery electively and were excluded from the data analysis. Patient demographics and previous bariatric surgery is displayed in Table 1. Perioperative (<30 days) and follow up (>30 days) data are shown in Tables 2 & 3. Early and late complications are shown in Figures 1 & 2 respectively. Weight loss post LRYGB is displayed in Table 4. 1 patient died 10 months post LRYGB.
Figure 2 – Late (>30d) complications post LRYGB
Time since LRYGB
Mean % excess weight loss (range)
6 months
54.2 (22.2 to 99.8)
1 year
64.2 (11.0 to 113.3)
2 years
67.3 (6.2 to 105.8)
3 years
65.2 (28.6 to 101.6)
4 years
64.3 (30.2 to 90.8)
Mean age
43.6 years
Females (%)
346 (82.4%)
Mean preoperative BMI
51.1 kg/m2
Patients with BMI ≥60
49 (11.7%)
Patients age ≥60 years
21 (5.0%)
Intragastric balloon
48 (11.4%)
Gastric band
41 (9.8%)
Table 1 –
Patient demographics & bariatric history
Table 4 – Mean % excess weight loss post LRYGB
Discussion
Mean operating time
2h 53m
Mean post op hospital stay
3.3 days
Early (<30d) readmission rate
5.9%
Conversion to open (%)
3 (0.7%)
Table 2 –
Perioperative outcomes
(<30 days)
We report safe and effective performance of LRYGB in our unit, with acceptable morbidity, mortality and weight loss that is comparable with other published studies1-3. Our results include the learning curve of all three consultant surgeons.
Anastamotic strictures occurred at the gastro-jejunostomy in the first 100 patients where circular stapler was used. That was changed subsequently to linear gastro-jejunostomy with resolution of this complication.
References
Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: a systematic review and meta-analysis. JAMA Oct 13;292(14):
Wittgrove AC, Clark GW. Laparoscopic Roux-en-Y gastric bypass in 500 patients: technique and results, with 3-60 month follow-up. Obes Surg 2000;10:233-9.
Higa KD, Boone KB, Ho T et al. Complications of the laparoscopic Roux-en-Y gastric bypass: 1040 patients – what have we learned? Obes Surg 2000;10:
Figure 1 – Early (<30 days) complications post LRYGB
Late (>30d readmission rate)
11.5%
Mean follow-up
17.4 months
Post op cholecystectomy
10 (2.4%)
Mortality
0.2%
Table 3 – Follow up data (>30 days)