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World Journal of Surgery

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01-08-2016 | Original Scientific Report

Laparoscopic Roux en-Y Gastric Bypass Using a Modified Retrocolic–Supracolic Approach: Outcomes from 300 Patients

Authors: Waleed Al-Khyatt, Charles A. Bull, Sherif Awad, Javed Ahmed

Published in: World Journal of Surgery | Issue 8/2016

Abstract

Background

Laparoscopic Roux en-Y gastric bypass (LRYGB) achieves sustained long-term weight loss and reduced mortality in morbidly obese patients. It is routinely performed using an ante- or retrocolic approach with the jejuno-jejunostomy constructed in the infracolic compartment. We have modified the standard technique of performing LRYGB by constructing both anastomoses in the supracolic compartment. This study describes the outcomes of consecutive primary LRYGB performed using this novel retrocolic–supracolic approach.

Methods

Data were prospectively collected on consecutive primary LRYGB performed in a tertiary-referral Bariatric Centre in the United Kingdom from September 2009 to March 2013. Data included demographics, operative outcomes (duration of surgery, postoperative anastomotic leak/bleeding/reoperations), development of strictures, length of stay, excess weight loss (EWL) and resolution of diabetes mellitus.

Results

Hand-sewn LRYGB was successfully performed using the retrocolic–supracolic approach in 300 of 307 (98 %) consecutive patients (72 % female). Median (IQR) age, weight and baseline body mass index were 49 (41–56) years, 146 (134–163) kg and 52.9 (48.8–57.2) kg/m², respectively. There were 4 (1.3 %) anastomotic leaks and 8 (2.6 %) postoperative bleeds. The 30-day reoperation rate was 1.6 %. Median (IQR) hospital stay was 2 (2–2) days. Postoperative dysphagia requiring endoscopic balloon dilatation occurred in 19 (6.3 %) patients. Mean ± SD 12-month EWL was 69.9 ± 19.0 %. Within the follow-up period, 81 % of patients with type II diabetes mellitus achieved remission and 19 % reduced dosage of diabetes medication.

Conclusions

LRYGB performed using the retrocolic–supracolic approach was safe, feasible, technically advantageous and resulted in clinical outcomes akin to the standard infracolic approach.

Buchwald H et al (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292(14):1724–1737CrossRefPubMed

Sjostrom L et al (2007) Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 357(8):741–752CrossRefPubMed

Wittgrove AC, Clark GW, Tremblay LJ (1994) Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg 4(4):353–357CrossRefPubMed

Higa KD et al (2000) Laparoscopic Roux-en-Y gastric bypass for morbid obesity: technique and preliminary results of our first 400 patients. Arch Surg 135(9):1029–1033 discussion 1033–1034 CrossRefPubMed

Schauer P, Conference ABSC (2005) Gastric bypass for severe obesity: approaches and outcomes. Surg Obes Relat Dis 1(3):297–300CrossRefPubMed

Lannoo M, Dillemans B (2014) Laparoscopy for primary and secondary bariatric procedures. Best Pract Res Clin Gastroenterol 28(1):159–173CrossRefPubMed

Himpens JM (2004) The gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass. Semin Laparosc Surg 11(3):171–177PubMed

de la Torre RA, Scott JS (1999) Laparoscopic Roux-en-Y gastric bypass: a totally intra-abdominal approach–technique and preliminary report. Obes Surg 9(5):492–498CrossRefPubMed

Madan AK, Harper JL, Tichansky DS (2008) Techniques of laparoscopic gastric bypass: on-line survey of American Society for Bariatric Surgery practicing surgeons. Surg Obes Relat Dis 4(2):166–172 discussion 172–173 CrossRefPubMed

10.

DeMaria EJ, Portenier D, Wolfe L (2007) Obesity surgery mortality risk score: proposal for a clinically useful score to predict mortality risk in patients undergoing gastric bypass. Surg Obes Relat Dis 3(2):134–140CrossRefPubMed

11.

Ahmed J, Al-Khyatt W (2016) LRYGB: The hand-sewn technique. In: Agrawal S (ed) Obesity, bariatric and metabolic surgery. Springer, New York, pp 191–196CrossRef

12.

Pournaras DJ et al (2010) Three hundred laparoscopic Roux-en-Y gastric bypasses: managing the learning curve in higher risk patients. Obes Surg 20(3):290–294CrossRefPubMed

13.

Abdel-Galil E, Sabry AA (2002) Laparoscopic Roux-en-Y gastric bypass–evaluation of three different techniques. Obes Surg 12(5):639–642CrossRefPubMed

14.

Gonzalez R et al (2003) Gastrojejunostomy during laparoscopic gastric bypass: analysis of 3 techniques. Arch Surg 138(2):181–184CrossRefPubMed

15.

Higa KD, Boone KB, Ho T (2000) Complications of the laparoscopic Roux-en-Y gastric bypass: 1040 patients—what have we learned? Obes Surg 10(6):509–513CrossRefPubMed

16.

Bamgbade OA, Adeogun BO, Abbas K (2012) Fast-track laparoscopic gastric bypass surgery: outcomes and lessons from a bariatric surgery service in the United Kingdom. Obes Surg 22(3):398–402CrossRefPubMed

17.

Bendewald FP et al (2011) Comparison of hand-sewn, linear-stapled, and circular-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass. Obes Surg 21(11):1671–1675CrossRefPubMed

18.

Giordano S, Tolonen P, Victorzon M (2010) Comparision of linear versus circular stapling techniques in laparoscopic gastric bypass surgery—a pilot study. Scand J Surg 99(3):127–131PubMed

19.

Leyba JL et al (2008) Laparoscopic gastric bypass for morbid obesity-a randomized controlled trial comparing two gastrojejunal anastomosis techniques. JSLS 12(4):385–388PubMedPubMedCentral

20.

Shope TR et al (2003) Early results after laparoscopic gastric bypass: EEA vs GIA stapled gastrojejunal anastomosis. Obes Surg 13(3):355–359CrossRefPubMed

21.

Cottam DR et al (2009) The effect of stoma size on weight loss after laparoscopic gastric bypass surgery: results of a blinded randomized controlled trial. Obes Surg 19(1):13–17CrossRefPubMed

22.

Sekhar N et al (2006) Endoscopic evaluation of the gastrojejunostomy in laparoscopic gastric bypass. A series of 340 patients without postoperative leak. Surg Endosc 20(2):199–201CrossRefPubMed

23.

Kravetz AJ et al (2011) A comparative study of handsewn versus stapled gastrojejunal anastomosis in laparoscopic Roux-en-Y gastric bypass. Surg Endosc 25(4):1287–1292CrossRefPubMed

24.

Awad S et al (2014) Outcomes of linear-stapled versus hand-sewn gastrojejunal anastomosis in laparoscopic Roux en-Y gastric bypass. Surg Endosc 29(8):2278–2283CrossRefPubMed

Title: Laparoscopic Roux en-Y Gastric Bypass Using a Modified Retrocolic–Supracolic Approach: Outcomes from 300 Patients
Authors: Waleed Al-Khyatt
Charles A. Bull
Sherif Awad
Javed Ahmed
Publication date: 01-08-2016
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 8/2016
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-016-3478-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Laparoscopic Roux en-Y Gastric Bypass Using a Modified Retrocolic–Supracolic Approach: Outcomes from 300 Patients

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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