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Laparoscopic Roux-en-Y gastric bypass with 2-metre long biliopancreatic limb for morbid obesity: technique and experience with the first 150 patients.

Abstract

BACKGROUND

Laparoscopic Roux-en-Y gastric bypass (RYGBP) is being performed widely as a treatment of choice for morbid obesity. We present our method and experience with the first 150 consecutive cases of laparoscopic RYGBP with a 2-m long biliopancreatic limb (BP-limb).

METHODS

Between November 2001 and November 2003, a prospective analysis of 150 patients was performed identifying technical success and complications. Before surgery, patients underwent a strict multidisciplinary behavioral program. At operation the stomach was transected proximally with a linear stapler (60-mm, Endo-GIA) to create a prolongation of the esophagus (gastric tube) along the lesser curvature, resulting in a 40-50 ml pouch. Two meters of the proximal jejunum were bypassed (BP-limb), creating an antecolic Roux-en-Y gastro-jejunostomy to the posterior wall of the gastric tube using a 45-mm linear Endo-GIA stapler. The entero-anastomosis was created 50 cm below the gastro-jejunostomy, also with a 45-mm linear Endo-GIA.

RESULTS

Mean BMI was 50.0, and 78% of patients were females. With 100% follow-up, we found an EWL of 50% 6 months after surgery, gradually rising to 80% after 18 months. The mean operating time was 116 min for the first 50 cases and decreased to 82 min for the last 50 cases. Intestinal leakage occurred in 5 patients (3%) and bleeding in 5 (3%). Most of these complications occurred in the first 50 cases, and all but one were treated successfully with an early laparoscopic re-operation. Marginal ulcers were found in 16.6% of patients. No internal hernias have occurred.

CONCLUSION

The operation demands advanced laparoscopic skills, but technically it is relatively simple and has an acceptable complication rate. Short-term results regarding excess weight loss are at least comparable to the RYGBP with a long alimentary limb.

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Department of Surgery, Landspítali University Hospital, Reykjavik, Iceland.

    Source

    Obesity surgery 15:1 2005 Jan pg 35-42

    MeSH

    Adolescent
    Adult
    Anastomosis, Roux-en-Y
    Biliopancreatic Diversion
    Body Mass Index
    Combined Modality Therapy
    Evaluation Studies as Topic
    Female
    Follow-Up Studies
    Gastric Bypass
    Humans
    Laparoscopy
    Male
    Middle Aged
    Obesity, Morbid
    Postoperative Complications
    Prospective Studies
    Risk Assessment
    Severity of Illness Index
    Sutures
    Treatment Outcome
    Weight Loss

    Pub Type(s)

    Comparative Study
    Journal Article

    Language

    eng

    PubMed ID

    15760497

    Citation

    Leifsson, Björn Geir, and Hjörtur Georg Gislason. "Laparoscopic Roux-en-Y Gastric Bypass With 2-metre Long Biliopancreatic Limb for Morbid Obesity: Technique and Experience With the First 150 Patients." Obesity Surgery, vol. 15, no. 1, 2005, pp. 35-42.
    Leifsson BG, Gislason HG. Laparoscopic Roux-en-Y gastric bypass with 2-metre long biliopancreatic limb for morbid obesity: technique and experience with the first 150 patients. Obes Surg. 2005;15(1):35-42.
    Leifsson, B. G., & Gislason, H. G. (2005). Laparoscopic Roux-en-Y gastric bypass with 2-metre long biliopancreatic limb for morbid obesity: technique and experience with the first 150 patients. Obesity Surgery, 15(1), pp. 35-42.
    Leifsson BG, Gislason HG. Laparoscopic Roux-en-Y Gastric Bypass With 2-metre Long Biliopancreatic Limb for Morbid Obesity: Technique and Experience With the First 150 Patients. Obes Surg. 2005;15(1):35-42. PubMed PMID: 15760497.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Laparoscopic Roux-en-Y gastric bypass with 2-metre long biliopancreatic limb for morbid obesity: technique and experience with the first 150 patients. AU - Leifsson,Björn Geir, AU - Gislason,Hjörtur Georg, PY - 2005/3/12/pubmed PY - 2005/4/6/medline PY - 2005/3/12/entrez SP - 35 EP - 42 JF - Obesity surgery JO - Obes Surg VL - 15 IS - 1 N2 - BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (RYGBP) is being performed widely as a treatment of choice for morbid obesity. We present our method and experience with the first 150 consecutive cases of laparoscopic RYGBP with a 2-m long biliopancreatic limb (BP-limb). METHODS: Between November 2001 and November 2003, a prospective analysis of 150 patients was performed identifying technical success and complications. Before surgery, patients underwent a strict multidisciplinary behavioral program. At operation the stomach was transected proximally with a linear stapler (60-mm, Endo-GIA) to create a prolongation of the esophagus (gastric tube) along the lesser curvature, resulting in a 40-50 ml pouch. Two meters of the proximal jejunum were bypassed (BP-limb), creating an antecolic Roux-en-Y gastro-jejunostomy to the posterior wall of the gastric tube using a 45-mm linear Endo-GIA stapler. The entero-anastomosis was created 50 cm below the gastro-jejunostomy, also with a 45-mm linear Endo-GIA. RESULTS: Mean BMI was 50.0, and 78% of patients were females. With 100% follow-up, we found an EWL of 50% 6 months after surgery, gradually rising to 80% after 18 months. The mean operating time was 116 min for the first 50 cases and decreased to 82 min for the last 50 cases. Intestinal leakage occurred in 5 patients (3%) and bleeding in 5 (3%). Most of these complications occurred in the first 50 cases, and all but one were treated successfully with an early laparoscopic re-operation. Marginal ulcers were found in 16.6% of patients. No internal hernias have occurred. CONCLUSION: The operation demands advanced laparoscopic skills, but technically it is relatively simple and has an acceptable complication rate. Short-term results regarding excess weight loss are at least comparable to the RYGBP with a long alimentary limb. SN - 0960-8923 UR - https://www.unboundmedicine.com/medline/citation/15760497/Laparoscopic_Roux_en_Y_gastric_bypass_with_2_metre_long_biliopancreatic_limb_for_morbid_obesity:_technique_and_experience_with_the_first_150_patients_ L2 - https://dx.doi.org/10.1381/0960892052993396 DB - PRIME DP - Unbound Medicine ER -