Roux en Y gastric bypass by single-incision mini-laparotomy: outcomes in 3,300 consecutive patients.

BACKGROUND: Although the laparoscopic technique of Roux en Y gastric bypass (LRYGB) has popularized this weight loss procedure, the costs are justifiable if outcomes are superior to the open technique. We report our results with single-incision mini-laparotomy. METHODS: From June 2000 through November 2009, RYGB was performed in 3,300 consecutive patients using a 10-15-cm single-abdominal incision. Established guidelines for patient selection were followed and protocols were developed for patient education and for the prevention of perioperative complications. Weight loss (WL) over time and complications were recorded prospectively. Actual 90-day mortality was compared to that predicted by the Obesity Surgery Mortality Risk Score (OS-MRS). RESULTS: Eighty-four percent of patients were females with a mean body mass index (BMI) of 50 ± 13. BMI of males was 54 ± 9. There was a normal distribution of the WL response over 2,000 days. Complications included bleeding (1.4%), leak (1%), pulmonary embolism (0.7%), internal hernia (2.5%), and incisional hernia (5.6%). There were 1,793 Class A, 1,288 Class B, and 219 Class C patients. Eleven patients (0.3%) died within 90 days (one Class A, seven Class B, and three Class C), with mortality rates in all classes less than expected by the OS-MRS. Average hospital charges were $13,000. CONCLUSIONS: Our protocols and operative technique should be reproducible in other centers and may have a special appeal, if the costs of LRYGB limit access to bariatric surgery in qualified patients.

Evaluation of bariatric Centers of Excellence Web sites for functionality and efficacy.

BACKGROUND: The Internet is a valuable method of information sharing and could have important applications for bariatric surgical practices. The purpose of this study was to devise criteria by which Centers of Excellence Web sites could be evaluated. By applying these criteria to the study sample, we hoped to identify specific content that could improve Web site functionality and, thereby, its efficacy. METHODS: We developed an original survey instrument that used specific criteria of Web site content to determine its functionality. The categories of content were Marketing, Interactivity, Education, and Support. Each of these categories was further divided into 3-7 subcategories for more in-depth analysis. From the Surgical Review Committee Web site page, 66 Centers of Excellence Web sites met our inclusion criteria of private, exclusively bariatric surgery practices. We then applied the survey instrument to evaluate their functionality. RESULTS: The survey revealed marketing and education content in all sites, and nearly all were interactive and provided patient support. However, all Web sites had deficiencies in >1 subcategory. CONCLUSION: Many Centers of Excellence have a Web presence. However, the opportunity exists to increase Web site functionality and efficacy by improving content in specific areas and using up-to-date technology.