Laparoscopic Roux-en-Y Gastric Bypass in the Megaobese .

HYPOTHESIS: Laparoscopic Roux-en-Y gastric bypass is a safe and effective procedure in patients with a body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters) of 70 or greater. DESIGN: A retrospective analysis of patients with a BMI of 70 or greater who underwent laparoscopic Roux-en-Y gastric bypass by a single surgeon. SETTING: A university-affiliated community hospital in Allentown, Pa. PATIENTS: A nonconsecutive series of 9 patients with a BMI of 70 or greater who met traditional criteria for a bariatric procedure. INTERVENTION: Laparoscopic approach to Roux-en-Y gastric bypass with stapled anastomoses. RESULTS: Patient medical records were reviewed for length of stay, complications, operative time, comorbidities, and weight loss. Seven patients were women and 2 were men. Comorbidities included dyspnea on exertion, peripheral edema, arthritis, sleep apnea, hypertension, diabetes mellitus, asthma, hypothyroidism, gastroesophageal reflux disease, peptic ulcer disease, and heart disease. Eight of 9 procedures were successfully completed laparoscopically. One patient was converted to an open procedure. One patient developed a marginal ulcer postoperatively. No other complications occurred. Operative time ranged from 122 to 330 minutes (mean, 203 minutes). Length of stay averaged 1.2 days. Overall weight loss was 49% of excess body weight at 1 year after surgery. CONCLUSION: Laparoscopic Roux-en-Y gastric bypass is safe and effective in patients with a BMI of 70 or greater

Laparoscopic Roux-en-Y Gastric Bypass and the Role of the Surgical Resident.

BACKGROUND: Open Roux-en-Y gastric bypass (RYGB) is the gold standard for obesity surgery in this country. The introduction of a totally laparoscopic technique in 1994 has increased the demand for obesity surgery and for this particular approach. Several studies show comparable results and complications between the open and laparoscopic procedure. However, the continued study of surgical technique, analysis of results, and, in particular, the education of the surgical resident in this approach must be accomplished. METHODS: A retrospective analysis was performed of 204 patients undergoing attempted laparoscopic RYGB, with surgical resident involvement, from March of 2000 to April of 2002. Surgical candidates had a body mass index (BMI) greater than 40 with a history of failed diets. All procedures were performed by a single board-certified general surgeon (P.F.R.) at a tertiary-care, teaching, community hospital with surgical residents assisting. Age, sex, ideal body weight, preoperative BMI and weight, surgical time, length of stay, complications, and resident level and role were recorded. Surgical technique was refined during the study period. RESULTS: A total of 204 patients underwent attempted laparoscopic RYGB with 4 (2%) being converted to open procedures and 1 mortality. Surgical time averaged 182 minutes. The average length of stay was 1.8 days. Four patients (2%) developed postoperative anastomotic leaks. Three patients (1.5%) developed internal hernias requiring reoperation. Four patients (2%) developed postoperative hemorrhage. One patient (0.5%) had a pulmonary embolism. Surgical residents were involved in all procedures and gradually expanded their role as skill increased. CONCLUSIONS: Laparoscopic RYGB can be performed safely in a community setting with surgical residents as either assistant or surgeon, further preparing them to perform this and other advanced laparoscopic procedures after completion of their training