Caroline M J Theunissen1, John K Maring2, Natascha J C Raeijmaekers3, Ingrid S Martijnse2, Barbara S Langenhoff2. 1. Department of Surgery, Elisabeth-TweeSteden Hospital, Dr. Deelenlaan 5, 5042 AD, Tilburg, Netherlands. ctheunissen@tsz.nl. 2. Department of Surgery, Elisabeth-TweeSteden Hospital, Dr. Deelenlaan 5, 5042 AD, Tilburg, Netherlands. 3. Department of Nutrition, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands.
Abstract
BACKGROUND: Even though admission time is reduced with the implementation of various enhanced recovery protocols, many clinics still instruct patients after weight loss surgery to maintain a fluid or minced-food diet for at least 2 weeks postoperatively. We reasoned that with adequate preoperative instructions, including adequate chewing of all foods, early progression to solid foods would not increase the risk of (gastro)enterostomy leakage. METHODS: In December 2010, a new dietary protocol was implemented for all patients undergoing a Roux-en-Y gastric bypass, allowing progression to solid foods from 12 h postprocedure onwards. All patients received thorough preoperative eating instructions and eating awareness counselling from a qualified dietician and psychologist. A retrospective study was performed of 936 patients who underwent a primary or redo laparoscopic Roux-en-Y gastric bypass between January 2011 and June 2014 in our hospital. All 30-day complications, readmissions and reoperations were noted. RESULTS: No 30-day loss to follow-up occurred. Overall 30-day complication rate was 9.4%, with gastrointestinal leakage occurring in only 0.6%. A low threshold for readmission was maintained due to the short mean admission time of 1.87 days. Readmission rate was 4.8%--mainly for observation of postoperative pain--and 1.8% of our patients required reoperation within 30 days. Mortality was 0.1%. Our results are comparable to results published by other Dutch centres advocating conventional diets, showing no increase in leakage or other complications. CONCLUSIONS: We conclude that early progression to solid foods after Roux-en-Y gastric bypass surgery is a feasible alternative as no increase in complications is observed.
BACKGROUND: Even though admission time is reduced with the implementation of various enhanced recovery protocols, many clinics still instruct patients after weight loss surgery to maintain a fluid or minced-food diet for at least 2 weeks postoperatively. We reasoned that with adequate preoperative instructions, including adequate chewing of all foods, early progression to solid foods would not increase the risk of (gastro)enterostomy leakage. METHODS: In December 2010, a new dietary protocol was implemented for all patients undergoing a Roux-en-Y gastric bypass, allowing progression to solid foods from 12 h postprocedure onwards. All patients received thorough preoperative eating instructions and eating awareness counselling from a qualified dietician and psychologist. A retrospective study was performed of 936 patients who underwent a primary or redo laparoscopic Roux-en-Y gastric bypass between January 2011 and June 2014 in our hospital. All 30-day complications, readmissions and reoperations were noted. RESULTS: No 30-day loss to follow-up occurred. Overall 30-day complication rate was 9.4%, with gastrointestinal leakage occurring in only 0.6%. A low threshold for readmission was maintained due to the short mean admission time of 1.87 days. Readmission rate was 4.8%--mainly for observation of postoperative pain--and 1.8% of our patients required reoperation within 30 days. Mortality was 0.1%. Our results are comparable to results published by other Dutch centres advocating conventional diets, showing no increase in leakage or other complications. CONCLUSIONS: We conclude that early progression to solid foods after Roux-en-Y gastric bypass surgery is a feasible alternative as no increase in complications is observed.
Authors: Kristoffer Lassen; Mattias Soop; Jonas Nygren; P Boris W Cox; Paul O Hendry; Claudia Spies; Maarten F von Meyenfeldt; Kenneth C H Fearon; Arthur Revhaug; Stig Norderval; Olle Ljungqvist; Dileep N Lobo; Cornelis H C Dejong Journal: Arch Surg Date: 2009-10
Authors: M Molly McMahon; Michael G Sarr; Matthew M Clark; Margaret M Gall; James Knoetgen; F John Service; Edward R Laskowski; Daniel L Hurley Journal: Mayo Clin Proc Date: 2006-10 Impact factor: 7.616
Authors: D P Lemanu; P P Singh; K Berridge; M Burr; C Birch; R Babor; A D MacCormick; B Arroll; A G Hill Journal: Br J Surg Date: 2013-01-21 Impact factor: 6.939