Laparoscopic management of complications following laparoscopic Roux-en-Y gastric bypass for morbid obesity.

BACKGROUND: We reviewed our experience with complications following laparoscopic Roux-en-Y gastric bypass (LRYGB) that were managed laparoscopically. METHODS: A total of 246 consecutive morbidly obese patients (mean body mass index, 50.9 kg/m2) underwent LRYGB by three surgeons at two institutions. All patients met National Institutes of Health criteria for surgical treatment of morbid obesity. Patients were followed prospectively. RESULTS: A total of 62 patients (25.2%) developed 64 complications, 34 of which (13.8%) required a surgical intervention. Twenty-seven of the 34 procedures were performed laparoscopically. Gastrojejunostomy stricture was the most common complication (8.9%), followed by intestinal obstruction (7.3%) and gastrointestinal bleeding (4%). The intestinal obstruction was secondary to adhesions (n = 6), internal hernia at the level of the transverse mesocolon (n = 3), jejunojejunostomy stricture (n = 3), and cicatrix around the Roux limb at the level of the transverse mesocolon (n = 3). Other complications included gastrojejunostomy leak (1.6%), symptomatic gallstone disease (2.8%), and gastric remnant perforation (0.8%). One patient underwent a negative laparoscopy to rule out anastomotic leak. There were 3 deaths in this series of patients, 2 attributable to anastomotic leak. CONCLUSIONS: A variety of complications can present after LRYGB. Laparoscopy is an excellent technique to treat these complications.

Outcome analysis of laparoscopic Roux-en-Y gastric bypass for morbid obesity. The first 116 cases.

BACKGROUND: Morbid obesity has been described as a continuing epidemic affecting a growing portion of our population. We report an outcome analysis of our early experience with laparoscopic Roux-en-Y gastric bypass (LRYGB) in the treatment of morbid obesity. METHODS: Two surgeons performed 116 consecutive LRYGBs at a single institution, creating a 25-ml pouch and a 90- to 150-cm Roux limb. The prospectively collected data included patient demographics, comorbidities, postoperative weight loss, and complications. RESULTS: All eight conversions to an open procedure occurred early during the experience of the surgeons. The mean operating room time for the first 50 cases was 272 min, which decreased to 198 min with experience. The mean length of hospital stay was 3 days. There were 34 complications in 27 patients (23.3%), 14 of which (12%) required reoperation. At 18 months postoperatively, the patients had lost 77% of their excess weight, and their body mass index had decreased from a mean of 49.3 to 32.6 kg/m2. As a result of LRYGB, 25% of the patients were rendered completely free of any pharmacologic treatment for their preexisting comorbidities. CONCLUSIONS: Although technically challenging, LRYGB can be performed safely with excellent long-term results. The mean operating room time and conversion rate improved with experience. As this study showed, LRYGB achieves an excellent rate of weight loss and improvement in preoperative comorbidities with a minimal length of hospital stay and an acceptable complication rate.