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. 2000 Oct;232(4):515-29.
doi: 10.1097/00000658-200010000-00007.

Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity

P R Schauer  1 , S Ikramuddin, W Gourash, R Ramanathan, J Luketich
Affiliations

Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity

P R Schauer et al. Ann Surg. 2000 Oct.

Abstract

Objective: To evaluate the short-term outcomes for laparoscopic Roux-en-Y gastric bypass in 275 patients with a follow-up of 1 to 31 months.

Summary background data: The Roux-en-Y gastric bypass is a highly successful approach to morbid obesity but results in significant perioperative complications. A laparoscopic approach has significant potential to reduce perioperative complications and recovery time.

Methods: Consecutive patients (n = 275) who met NIH criteria for bariatric surgery were offered laparoscopic Roux-en-Y gastric bypass between July 1997 and March 2000. A 15-mL gastric pouch and a 75-cm Roux limb (150 cm for superobese) was created using five or six trocar incisions.

Results: The conversion rate to open gastric bypass was 1%. The start of an oral diet began a mean of 1.58 days after surgery, with a median hospital stay of 2 days and return to work at 21 days. The incidence of early major and minor complications was 3.3% and 27%, respectively. One death occurred related to a pulmonary embolus (0.4%). The hernia rate was 0.7%, and wound infections requiring outpatient drainage only were uncommon (5%). Excess weight loss at 24 and 30 months was 83% and 77%, respectively. In patients with more than 1 year of follow-up, most of the comorbidities were improved or resolved, and 95% reported significant improvement in quality of life.

Conclusion: Laparoscopic Roux-en-Y gastric bypass is effective in achieving weight loss and in improving comorbidities and quality of life while reducing recovery time and perioperative complications.

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Figures

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Figure 1. Port placement for laparoscopic Roux-en-Y gastric bypass.
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Figure 10. Closure of enterotomy of end-to-side anastomosis.
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Figure 11. Excess weight loss, 0 to 30 months.
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Figure 12. Change in body mass index, 0 to 30 months.
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Figure 2. Creation of gastric pouch.
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Figure 3. Creation of Roux limb and mesenteric division.
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Figure 4. Creation of jejunojejunostomy and closure of mesenteric defect.
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Figure 5. Passage of Roux limb through retrocolic retrogastric tunnel.
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Figure 6. Passage of snare wire for end-to-end anastomosis.
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Figure 7. Placement of anvil for end-to-end anastomosis.
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Figure 8. Creation of gastrojejunostomy: circular stapled technique.
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Figure 9. Creation of gastrojejunostomy: end-to-side anastomosis.
See this image and copyright information in PMC

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