Skip to main content
Top
Published in: Obesity Surgery 3/2009

01-03-2009 | Research Article

Hospital Discharge in the Day Following Open Roux-en-Y Gastric Bypass: Is it Feasible and Safe?

Authors: Iran dos Santos Moraes Jr., Carlos Augusto Scussel Madalosso, Luis Amauri Palma, Adriana Cristina da Silva Fornari, Maria do Socorro Dourado, Tiago Scherer, Richard Ricachenevsky Gurski, Fernando Fornari

Published in: Obesity Surgery | Issue 3/2009

Login to get access

Abstract

Background

Roux-en-Y gastric bypass (RYGBP) either laparoscopic or open has been increasingly employed in the treatment of patients with morbid obesity. Laparoscopic approach is believed to be superior over open approach in terms of shorter hospital stay and easier recovery. We aimed to assess feasibility and safety of open RYGBP with short stay in comparison with laparoscopic RYGBP.

Methods

One hundred and ninety consecutive patients were assigned to open (n = 103) or laparoscopic (n = 87) RYGBP. The first 20 patients of the laparoscopic arm were excluded due to procedure learning curve. Patients were treated by a multidisciplinary team focused on successfully RYGBP with short stay (1 day).

Results

Short stay was reached by 90% of patients operated with open approach and 81% by laparoscopy (P = 0.070). Discharge in the second day was reached by 97% of patients in both groups. Procedure length [(median (IQR)] was faster for open RYGBP [103 (70–180 min) vs. 169 (105–248 min); P < 0.0001]. Thirty-day readmission rate was similar between groups (3% vs. 7%; P = 0.266). There was no death in either group.

Conclusion

Short stay (1 day) following open gastric bypass was a feasible and safe procedure. This approach might have economic impact and might increase patient acceptance for open RYGBP.
Literature
1.
go back to reference Bray GA, Bellanger T. Epidemiology, trends, and morbidities of obesity and the metabolic syndrome. Endocrine 2006;29:109–17.CrossRef Bray GA, Bellanger T. Epidemiology, trends, and morbidities of obesity and the metabolic syndrome. Endocrine 2006;29:109–17.CrossRef
2.
go back to reference Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 2006;295:1549–55.CrossRef Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 2006;295:1549–55.CrossRef
3.
go back to reference Santos LM, Oliveira IV, Peters LR, et al. Trends in morbid obesity and in bariatric surgeries covered by the Brazilian Public Health System. Obes Surg. 2008, in press. Santos LM, Oliveira IV, Peters LR, et al. Trends in morbid obesity and in bariatric surgeries covered by the Brazilian Public Health System. Obes Surg. 2008, in press.
4.
go back to reference Dietz WH. Childhood weight affects adult morbidity and mortality. J Nutr. 1998;128:411S–4S.CrossRef Dietz WH. Childhood weight affects adult morbidity and mortality. J Nutr. 1998;128:411S–4S.CrossRef
5.
go back to reference Poves PI, Macias GJ, Cabrera FM, et al. Quality of life in morbid obesity. Rev Esp Enferm Dig. 2005;97:187–95. Poves PI, Macias GJ, Cabrera FM, et al. Quality of life in morbid obesity. Rev Esp Enferm Dig. 2005;97:187–95.
6.
go back to reference Wee CC, Davis RB, Hamel MB. Comparing the SF-12 and SF-36 health status questionnaires in patients with and without obesity. Health Qual Life Outcomes. 2008;6:11.CrossRef Wee CC, Davis RB, Hamel MB. Comparing the SF-12 and SF-36 health status questionnaires in patients with and without obesity. Health Qual Life Outcomes. 2008;6:11.CrossRef
7.
go back to reference Ali MR, Fuller WD, Choi MP, et al. Bariatric surgical outcomes. Surg Clin North Am. 2005;85:835–52, vii.CrossRef Ali MR, Fuller WD, Choi MP, et al. Bariatric surgical outcomes. Surg Clin North Am. 2005;85:835–52, vii.CrossRef
8.
go back to reference Must A, Spadano J, Coakley EH, et al. The disease burden associated with overweight and obesity. JAMA 1999;282:1523–9.CrossRef Must A, Spadano J, Coakley EH, et al. The disease burden associated with overweight and obesity. JAMA 1999;282:1523–9.CrossRef
9.
go back to reference Craig BM, Tseng DS. Cost-effectiveness of gastric bypass for severe obesity. Am J Med. 2002;113:491–8.CrossRef Craig BM, Tseng DS. Cost-effectiveness of gastric bypass for severe obesity. Am J Med. 2002;113:491–8.CrossRef
10.
go back to reference Elder KA, Wolfe BM. Bariatric surgery: a review of procedures and outcomes. Gastroenterology 2007;132:2253–71.CrossRef Elder KA, Wolfe BM. Bariatric surgery: a review of procedures and outcomes. Gastroenterology 2007;132:2253–71.CrossRef
11.
go back to reference Buchwald H, Williams SE. Bariatric surgery worldwide 2003. Obes Surg. 2004;14:1157–64.CrossRef Buchwald H, Williams SE. Bariatric surgery worldwide 2003. Obes Surg. 2004;14:1157–64.CrossRef
12.
go back to reference Pope GD, Finlayson SR, Kemp JA, et al. Life expectancy benefits of gastric bypass surgery. Surg Innov. 2006;13:265–73.CrossRef Pope GD, Finlayson SR, Kemp JA, et al. Life expectancy benefits of gastric bypass surgery. Surg Innov. 2006;13:265–73.CrossRef
13.
go back to reference Poves I, Cabrera M, Maristany C, et al. Gastrointestinal quality of life after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2006;16:19–23.CrossRef Poves I, Cabrera M, Maristany C, et al. Gastrointestinal quality of life after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2006;16:19–23.CrossRef
14.
go back to reference Batsis JA, Romero-Corral A, Collazo-Clavell ML, et al. Effect of bariatric surgery on the metabolic syndrome: a population-based, long-term controlled study. Mayo Clin Proc. 2008;83:897–907.CrossRef Batsis JA, Romero-Corral A, Collazo-Clavell ML, et al. Effect of bariatric surgery on the metabolic syndrome: a population-based, long-term controlled study. Mayo Clin Proc. 2008;83:897–907.CrossRef
15.
go back to reference Cummings S, Apovian CM, Khaodhiar L. Obesity surgery: evidence for diabetes prevention/management. J Am Diet Assoc. 2008;108:S40–4.CrossRef Cummings S, Apovian CM, Khaodhiar L. Obesity surgery: evidence for diabetes prevention/management. J Am Diet Assoc. 2008;108:S40–4.CrossRef
16.
go back to reference Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238:467–84.PubMedPubMedCentral Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238:467–84.PubMedPubMedCentral
17.
go back to reference Cottam DR, Nguyen NT, Eid GM, et al. The impact of laparoscopy on bariatric surgery. Surg Endosc. 2005;19:621–7.CrossRef Cottam DR, Nguyen NT, Eid GM, et al. The impact of laparoscopy on bariatric surgery. Surg Endosc. 2005;19:621–7.CrossRef
18.
go back to reference Nguyen NT, Goldman C, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;234:279–89.CrossRef Nguyen NT, Goldman C, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;234:279–89.CrossRef
19.
go back to reference Sekhar N, Torquati A, Youssef Y, et al. A comparison of 399 open and 568 laparoscopic gastric bypasses performed during a 4-year period. Surg Endosc. 2007;21:665–8.CrossRef Sekhar N, Torquati A, Youssef Y, et al. A comparison of 399 open and 568 laparoscopic gastric bypasses performed during a 4-year period. Surg Endosc. 2007;21:665–8.CrossRef
20.
go back to reference Jones KB Jr, Afram JD, Benotti PN, et al. Open versus laparoscopic Roux-en-Y gastric bypass: a comparative study of over 25,000 open cases and the major laparoscopic bariatric reported series. Obes Surg. 2006;16:721–7.CrossRef Jones KB Jr, Afram JD, Benotti PN, et al. Open versus laparoscopic Roux-en-Y gastric bypass: a comparative study of over 25,000 open cases and the major laparoscopic bariatric reported series. Obes Surg. 2006;16:721–7.CrossRef
21.
go back to reference Ballantyne GH, Svahn J, Capella RF, et al. Predictors of prolonged hospital stay following open and laparoscopic gastric bypass for morbid obesity: body mass index, length of surgery, sleep apnea, asthma, and the metabolic syndrome. Obes Surg. 2004;14:1042–50.CrossRef Ballantyne GH, Svahn J, Capella RF, et al. Predictors of prolonged hospital stay following open and laparoscopic gastric bypass for morbid obesity: body mass index, length of surgery, sleep apnea, asthma, and the metabolic syndrome. Obes Surg. 2004;14:1042–50.CrossRef
22.
go back to reference Lujan JA, Frutos MD, Hernandez Q, et al. Laparoscopic versus open gastric bypass in the treatment of morbid obesity: a randomized prospective study. Ann Surg. 2004;239:433–7.CrossRef Lujan JA, Frutos MD, Hernandez Q, et al. Laparoscopic versus open gastric bypass in the treatment of morbid obesity: a randomized prospective study. Ann Surg. 2004;239:433–7.CrossRef
23.
go back to reference Stellato TA, Hallowell PT, Crouse C, et al. Two-day length of stay following open Roux-En-Y gastric bypass: is it feasible, safe and reasonable? Obes Surg. 2004;14:27–34.CrossRef Stellato TA, Hallowell PT, Crouse C, et al. Two-day length of stay following open Roux-En-Y gastric bypass: is it feasible, safe and reasonable? Obes Surg. 2004;14:27–34.CrossRef
24.
go back to reference McCarty TM, Arnold DT, Lamont JP, et al. Optimizing outcomes in bariatric surgery: outpatient laparoscopic gastric bypass. Ann Surg. 2005;242:494–8.PubMedPubMedCentral McCarty TM, Arnold DT, Lamont JP, et al. Optimizing outcomes in bariatric surgery: outpatient laparoscopic gastric bypass. Ann Surg. 2005;242:494–8.PubMedPubMedCentral
25.
go back to reference Raeder J. Bariatric procedures as day/short stay surgery: is it possible and reasonable? Curr Opin Anaesthesiol. 2007;20:508–12.CrossRef Raeder J. Bariatric procedures as day/short stay surgery: is it possible and reasonable? Curr Opin Anaesthesiol. 2007;20:508–12.CrossRef
26.
go back to reference Ballesta-Lopez C, Poves I, Cabrera M, et al. Learning curve for laparoscopic Roux-en-Y gastric bypass with totally hand-sewn anastomosis: analysis of first 600 consecutive patients. Surg Endosc. 2005;19:519–24.CrossRef Ballesta-Lopez C, Poves I, Cabrera M, et al. Learning curve for laparoscopic Roux-en-Y gastric bypass with totally hand-sewn anastomosis: analysis of first 600 consecutive patients. Surg Endosc. 2005;19:519–24.CrossRef
27.
go back to reference Flum DR, Dellinger EP. Impact of gastric bypass operation on survival: a population-based analysis. J Am Coll Surg. 2004;199:543–51.CrossRef Flum DR, Dellinger EP. Impact of gastric bypass operation on survival: a population-based analysis. J Am Coll Surg. 2004;199:543–51.CrossRef
28.
go back to reference Zingmond DS, McGory ML, Ko CY. Hospitalization before and after gastric bypass surgery. JAMA 2005;294:1918–24.CrossRef Zingmond DS, McGory ML, Ko CY. Hospitalization before and after gastric bypass surgery. JAMA 2005;294:1918–24.CrossRef
29.
go back to reference Davis MM, Slish K, Chao C, et al. National trends in bariatric surgery, 1996–2002. Arch Surg. 2006;141:71–4.CrossRef Davis MM, Slish K, Chao C, et al. National trends in bariatric surgery, 1996–2002. Arch Surg. 2006;141:71–4.CrossRef
30.
go back to reference Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA 2005;294:1909–17.CrossRef Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA 2005;294:1909–17.CrossRef
31.
go back to reference Madan AK, Speck KE, Ternovits CA, et al. Outcome of a clinical pathway for discharge within 48 hours after laparoscopic gastric bypass. Am J Surg. 2006;192:399–402.CrossRef Madan AK, Speck KE, Ternovits CA, et al. Outcome of a clinical pathway for discharge within 48 hours after laparoscopic gastric bypass. Am J Surg. 2006;192:399–402.CrossRef
32.
go back to reference McCarty TM. Can bariatric surgery be done as an outpatient procedure? Adv Surg. 2006;40:99–106.CrossRef McCarty TM. Can bariatric surgery be done as an outpatient procedure? Adv Surg. 2006;40:99–106.CrossRef
33.
go back to reference Lara MD, Baker MT, Larson CJ, et al. Travel distance, age, and sex as factors in follow-up visit compliance in the post-gastric bypass population. Surg Obes Relat Dis. 2005;1:17–21.CrossRef Lara MD, Baker MT, Larson CJ, et al. Travel distance, age, and sex as factors in follow-up visit compliance in the post-gastric bypass population. Surg Obes Relat Dis. 2005;1:17–21.CrossRef
34.
go back to reference Saunders JK, Ballantyne GH, Belsley S, et al. 30-day readmission rates at a high volume bariatric surgery center: laparoscopic adjustable gastric banding, laparoscopic gastric bypass, and vertical banded gastroplasty-Roux-en-Y gastric bypass. Obes Surg. 2007;17:1171–7.CrossRef Saunders JK, Ballantyne GH, Belsley S, et al. 30-day readmission rates at a high volume bariatric surgery center: laparoscopic adjustable gastric banding, laparoscopic gastric bypass, and vertical banded gastroplasty-Roux-en-Y gastric bypass. Obes Surg. 2007;17:1171–7.CrossRef
35.
go back to reference Breaux JA, Kennedy CI, Richardson WS. Advanced laparoscopic skills decrease the learning curve for laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2007;21:985–8.CrossRef Breaux JA, Kennedy CI, Richardson WS. Advanced laparoscopic skills decrease the learning curve for laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2007;21:985–8.CrossRef
Metadata
Title
Hospital Discharge in the Day Following Open Roux-en-Y Gastric Bypass: Is it Feasible and Safe?
Authors
Iran dos Santos Moraes Jr.
Carlos Augusto Scussel Madalosso
Luis Amauri Palma
Adriana Cristina da Silva Fornari
Maria do Socorro Dourado
Tiago Scherer
Richard Ricachenevsky Gurski
Fernando Fornari
Publication date
01-03-2009
Publisher
Springer New York
Published in
Obesity Surgery / Issue 3/2009
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-008-9779-1

Other articles of this Issue 3/2009

Obesity Surgery 3/2009 Go to the issue