ABSTRACT
BACKGROUND: The introduction of robotics in bariatric surgery is a novel development since the beginning of this century. The aim of this study is to compare surgical outcome of the robotic gastric bypass with the laparoscopic counterpart. METHODS: A retrospective study was conducted to compare the results of 100 fully robotic gastric bypasses (RGB) and 100 laparoscopic gastric bypasses (LGB) performed by a single surgeon. Surgical outcome was analysed by evaluating operation room time and surgical time, morbidity and mortality, and length of hospital stay. RESULTS: In the RGB and LGB group, respectively, 92 and 80 % of operated patients were female (p = 0.024). Mean age was 39 (range 20-62, SD 10.21) and 42 years (range 18-65, SD 11.87), respectively (p = 0.158). Mean BMI was 40 (range 35-47, SD 2.66) and 42 (range 35-56, SD 4.75), respectively (p < 0.05). Mean surgical time was 67 (range 39-210, SD 22.46) and 31 min (range 18-62, SD 9.12), respectively (p < 0.05). Mean operation room time was 117 (range 80-257, SD 30.13) and 66 min (range 38-101, SD 12.68), respectively (p < 0.05). The surgery-related 30-day morbidity rate was 5 % in both groups. Major morbidity (Clavien-Dindo class 3-4) was 3 and 1 %, respectively (p = 0.62). There was no mortality. Median hospital stay was two postoperative days in both groups. A learning curve developed after 25 procedures. CONCLUSIONS: The RGB is a feasible procedure. Although more time is needed, a standardized technique results in fair operation times in the hands of an experienced surgeon.
Subject(s)
Gastric Bypass/methods , Obesity, Morbid/surgery , Robotic Surgical Procedures/methods , Adolescent , Adult , Aged , Feasibility Studies , Female , Humans , Laparoscopy/methods , Learning Curve , Length of Stay/statistics & numerical data , Male , Middle Aged , Operative Time , Retrospective Studies , Young AdultABSTRACT
Morbid obesity is a known risk factor for developing symptoms of urinary incontinence. However, it is not known if this leads to a high prevalence of perioperative incontinence and bladder retention after bariatric surgery because routine use of bladder catheterization is usual during this kind of surgery. The study was conducted at a general hospital in the Netherlands. Sixty morbidly obese female patients undergoing laparoscopic gastric bypass surgery were included in the present study. Preoperative urinary incontinence and risk factors were investigated by use of questionnaires. The following perioperative parameters were collected: operation time, total amount of intravenous fluids, preoperative urinary retention on the ward measured by bladder scan, postoperative urinary incontinence on the recovery room, postoperative urinary retention on the ward after passing urine measured by bladder scan, and observed urination on the ward. The prevalence of preoperative incontinence was 43 %. Nine patients (15 %) had postoperative urinary incontinence including four patients with known incontinence and five patients without. There were no differences between the patients with and without postoperative incontinence with relation to age, body mass index, diabetes mellitus, operation time, received amount of intravenous fluids and pre- and postoperative bladder scan residual volumes. Although the prevalence of urinary incontinence is high among morbidly obese female patients seeking bariatric surgery, postoperative incontinence was only present in 15 % of patients, and there was no need for catheterization for bladder retention. Preoperative risk factors for developing this kind of complications could not be identified.
Subject(s)
Gastric Bypass/adverse effects , Obesity, Morbid/surgery , Postoperative Complications/etiology , Urinary Bladder/injuries , Urinary Catheterization/adverse effects , Urinary Incontinence/etiology , Adult , Age Distribution , Cross-Sectional Studies , Female , Gastric Bypass/methods , Humans , Middle Aged , Netherlands/epidemiology , Obesity, Morbid/complications , Obesity, Morbid/epidemiology , Postoperative Complications/epidemiology , Prevalence , Risk Factors , Surveys and Questionnaires , Treatment Outcome , Urinary Incontinence/epidemiologyABSTRACT
BACKGROUND: Obstruction of the pancreatic duct can lead to pancreatic fibrosis. We investigated the correlation between the extent of pancreatic fibrosis and the postoperative exocrine and endocrine pancreatic function. METHODS: Fifty-five patients who were treated for pancreatic and periampullary carcinoma and 19 patients with chronic pancreatitis were evaluated. Exocrine pancreatic function was evaluated by fecal elastase-1 test, while endocrine pancreatic function was assessed by plasma glucose level. The extent of fibrosis, duct dilation and endocrine tissue loss was examined histopathologically. RESULTS: A strong correlation was found between pancreatic fibrosis and elastase-1 level less than 100 microg/g (p < 0.0001), reflecting severe exocrine pancreatic insufficiency. A strong correlation was found between pancreatic fibrosis and endocrine tissue loss (p < 0.0001). Neither pancreatic fibrosis nor endocrine tissue loss were correlated with the development of postoperative diabetes mellitus. Duct dilation alone was neither correlated with exocrine nor with endocrine function loss. CONCLUSION: The majority of patients develop severe exocrine pancreatic insufficiency after pancreatoduodenectomy. The extent of exocrine pancreatic insufficiency is strongly correlated with preoperative fibrosis. The loss of endocrine tissue does not correlate with postoperative diabetes mellitus. Preoperative dilation of the pancreatic duct per se does not predict exocrine or endocrine pancreatic insufficiency postoperatively.
