Gus J Slotman1. 1. Department of Surgery, UMDNJ, Camden, NJ, USA. doctorg49@aol.com
Abstract
BACKGROUND: Technical difficulties in laparoscopic gastric bypass for severely obese patients have led to sleeve gastrectomy first and then laparoscopic gastric bypass as a second stage after significant weight loss. Rather than commit these fragile patients to two operations, we have done open gastric bypass as a definitive surgical treatment for extreme obesity. METHODS: Office records of 61 patients with body mass index (BMI) of 70 and higher were reviewed. All underwent non-transectional open gastric bypass with a 150 cm Roux limb. Data included age, sex, weight, BMI, co-morbidities, operative information, length of stay (LOS), surgical morbidity, and percent excess weight loss (%XSWL). Data are in median (range). RESULTS: There were 21 (34%) men and 40 (66%) women: age, 37 years (19-53); pre-operative weight, 468 lb (300-650); and pre-operative BMI, 77 (70-95). Co-morbidities were diabetes mellitus, 26 (46%); hypertension, 26 (43%); sleep apnea, 61 (100%); gastroesophageal reflux disease, 20 (33%); and hypothyroid nine (15%). Incision length was 15 cm (12-20), abdominal wall fat thickness was 8 cm (5-13), operative time was 150 min (100-210), and estimated blood loss was 100 ml (25-750); post-op intensive care unit: yes 16 (26%) and no 44 (74%). LOS was 3 days for 44 patients (74%), 4 days for 11 (18%), 5 days for five (8%), and 7 days for one (1.6%). Post-operative morbidity was as follows: zero mortality, splenectomy, stoma leak, deep venous thrombosis, pulmonary embolus, GI bleeding, stomal ulcer, intestinal obstruction, fascial dehiscence, or 30-day readmission; wound infections in one (1.6%); skin wound separation in six (10%); pneumonia in one (1.6%); anemia in nine (14.8%); vitamin B(12) deficiency in six (10%); incisional hernia in 17 (28%); and gastric staple line disruption in two (3.3%). %XSWL were 51% in 1 year (28-84) and 60% in 2 years (27-97). CONCLUSIONS: Non-transectional open gastric bypass for patients with BMI of 70 and higher is safe and effective as a one-stage operation for severe obesity.
BACKGROUND: Technical difficulties in laparoscopic gastric bypass for severely obesepatients have led to sleeve gastrectomy first and then laparoscopic gastric bypass as a second stage after significant weight loss. Rather than commit these fragilepatients to two operations, we have done open gastric bypass as a definitive surgical treatment for extreme obesity. METHODS: Office records of 61 patients with body mass index (BMI) of 70 and higher were reviewed. All underwent non-transectional open gastric bypass with a 150 cm Roux limb. Data included age, sex, weight, BMI, co-morbidities, operative information, length of stay (LOS), surgical morbidity, and percent excess weight loss (%XSWL). Data are in median (range). RESULTS: There were 21 (34%) men and 40 (66%) women: age, 37 years (19-53); pre-operative weight, 468 lb (300-650); and pre-operative BMI, 77 (70-95). Co-morbidities were diabetes mellitus, 26 (46%); hypertension, 26 (43%); sleep apnea, 61 (100%); gastroesophageal reflux disease, 20 (33%); and hypothyroid nine (15%). Incision length was 15 cm (12-20), abdominal wall fat thickness was 8 cm (5-13), operative time was 150 min (100-210), and estimated blood loss was 100 ml (25-750); post-op intensive care unit: yes 16 (26%) and no 44 (74%). LOS was 3 days for 44 patients (74%), 4 days for 11 (18%), 5 days for five (8%), and 7 days for one (1.6%). Post-operative morbidity was as follows: zero mortality, splenectomy, stoma leak, deep venous thrombosis, pulmonary embolus, GI bleeding, stomal ulcer, intestinal obstruction, fascial dehiscence, or 30-day readmission; wound infections in one (1.6%); skin wound separation in six (10%); pneumonia in one (1.6%); anemia in nine (14.8%); vitamin B(12) deficiency in six (10%); incisional hernia in 17 (28%); and gastric staple line disruption in two (3.3%). %XSWL were 51% in 1 year (28-84) and 60% in 2 years (27-97). CONCLUSIONS: Non-transectional open gastric bypass for patients with BMI of 70 and higher is safe and effective as a one-stage operation for severe obesity.
Authors: D S Tichansky; E J DeMaria; A Z Fernandez; J M Kellum; L G Wolfe; J G Meador; H J Sugerman Journal: Surg Endosc Date: 2005-05-05 Impact factor: 4.584
Authors: Raquel Sánchez-Santos; Nuria Vilarrasa; Jorge Pujol; Pablo Moreno; Jose Manuel Francos; Antonio Rafecas; Carlos Masdevall Journal: Obes Surg Date: 2006-04 Impact factor: 4.129