Laparoscopic bariatric surgery can be performed safely in the community hospital setting

Abstract

Background: Bariatric surgery is being performed commonly in various practice settings. To evaluate safety and efficacy, we reviewed the results of our first 516 laparoscopic bariatric operations performed in a community hospital setting.

Methods: We reviewed retrospectively the results of our first 516 consecutive laparoscopic bariatric procedures.

Results: Between December 2001 and December 2004, we performed 516 bariatric surgical procedures. Ninety-nine percent of these were accomplished laparoscopically. Thirty-day mortality in our series of 516 patients is 0%. Of these patients, 431 had laparoscopic gastric bypass. The mean BMI in these patients was 51. Mean percent excess weight loss in the laparoscopic gastric bypass patients was 70% at 1 year, 79% at 2 years and 84% at 3 years. Complications in the laparoscopic bypass group requiring reoperation included 11 bowel obstructions (2.5%), 5 episodes of bleeding (1.1%), and 2 laparoscopies for benign reasons. There were 8 anastomotic leaks (1.9%)-7 requiring reoperation, 1 managed nonoperatively. Eighty-five patients had adjustable gastric banding. Mean BMI was 45. Mean percent excess weight loss in the adjustable gastric banding patients was 39% at 1 year and 57% at 2 years. Complications in the adjustable gastric band patients requiring reoperation included 3 access port malfunctions (3.5%), 3 prolapsed bands (3.5%), 1 punctured band requiring replacement (1.2%) and 1 band causing complete obstruction requiring removal (1.2%).

Conclusion: Laparoscopic bariatric surgery can be performed safely in the community hospital setting with a very low operative morbidity and mortality. This requires an experienced team of bariatric surgeons leading a multidisciplinary team of other health care professionals. Surgeon experience and super obesity can influence the risks.