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

Bruno Dillemans, Nasser Sakran, Sebastiaan Van Cauwenberge, Thibault Sablon, Barbara Defoort, Els Van Dessel, Faki Akin, Nathalie Moreels, Sebastiaan Lambert, Jan Mulier, Ravindra Date, Michel Vandelanotte, Tom Feryn, Luc Proot

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66 Scopus citations

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/m2 (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.

Original languageEnglish
Pages (from-to)1355-1364
Number of pages10
JournalObesity Surgery
Volume19
Issue number10
DOIs
StatePublished - Oct 2009
Externally publishedYes

Keywords

  • Bariatric surgery
  • Complications
  • Laparoscopy
  • Morbid obesity
  • Roux-en-Y gastric bypass

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