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Published in: Obesity Surgery 7/2008

01-07-2008 | Research Article

Laparoscopic Roux-en-Y Gastric Bypass for Morbidly Obese Chinese Patients: Learning Curve, Advocacy and Complications

Authors: Chih-Kun Huang, Yi-Chia Lee, Chao-Ming Hung, Yaw-Sen Chen, Chi-Ming Tai

Published in: Obesity Surgery | Issue 7/2008

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Abstract

Background

Laparoscopic Roux-en-Y gastric bypass (LRYGB) involves a combination of both restrictive and mal-absorptive mechanisms and has become the procedure of choice for patients with morbid obesity in Western countries. However, its efficacy remains uncertain in Asian populations. We report our pilot experience with LRYGB in a Chinese population.

Methods

Between August 2005 and February 2007, 100 morbidly obese patients received LRYGB. We evaluated the learning curve for the operation, its efficacy in weight reduction, and its postoperative complications.

Results

Surgical time reached a plateau after about 50 cases, decreasing from 216 min for the initial 50 patients to 105 min for the final 50. The conversion rate from laparoscopic to open surgery was 2%. The mean percent body mass index loss was 33.9% after 12 months. Twenty-four complications occurred in 18 patients, but most resolved with conservative treatment without mortality. Patients with advanced age (P = 0.04) or hypertension (P = 0.03) were at increased risk for complications leading to prolonged surgical times and hospital stays. The complication rate declined as technical expertise increased.

Conclusion

In Chinese patients with morbid obesity, LRYGB is promising procedure because of its acceptable learning curve, good efficacy, and low complication rate.
Literature
1.
go back to reference Allison DB, Fontaine KR, Manson JE, et al. Annual deaths attributable to obesity in the United States. JAMA. 1999;282:1530–8.PubMedCrossRef Allison DB, Fontaine KR, Manson JE, et al. Annual deaths attributable to obesity in the United States. JAMA. 1999;282:1530–8.PubMedCrossRef
2.
go back to reference Fisher BL, Schauer P. Medical and surgical options in the treatment of severe obesity. Am J Surg. 2002;12:569–72. Fisher BL, Schauer P. Medical and surgical options in the treatment of severe obesity. Am J Surg. 2002;12:569–72.
3.
4.
go back to reference Pories WJ, Swanson MD, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339–50.PubMedCrossRef Pories WJ, Swanson MD, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339–50.PubMedCrossRef
5.
go back to reference Sugerman HJ, Kellum JM, Engle KM, et al. Gastric bypass for treating severe obesity. Am J Clin Nutr. 1992;55:560S–6S.PubMed Sugerman HJ, Kellum JM, Engle KM, et al. Gastric bypass for treating severe obesity. Am J Clin Nutr. 1992;55:560S–6S.PubMed
6.
go back to reference Benotti PN, Forse RA. The role of gastric surgery in the multidisciplinary management of severe obesity. Am J Surg. 1995;169:361–7.PubMedCrossRef Benotti PN, Forse RA. The role of gastric surgery in the multidisciplinary management of severe obesity. Am J Surg. 1995;169:361–7.PubMedCrossRef
7.
go back to reference Pories WJ, MacDonald KG Jr, Morgan EJ, et al. Surgical treatment of obesity and its effect on diabetes: 10-year follow-up. Am J Clin. Nutr 1992;55:582S–5S.PubMed Pories WJ, MacDonald KG Jr, Morgan EJ, et al. Surgical treatment of obesity and its effect on diabetes: 10-year follow-up. Am J Clin. Nutr 1992;55:582S–5S.PubMed
8.
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.PubMedCrossRef 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.PubMedCrossRef
9.
go back to reference Suter M, Giusti V, Heraief E, et al. Laparoscopic Roux-en-Y gastric bypass: initial 2-year experience. Surg Endosc. 2003;17:603–9.PubMedCrossRef Suter M, Giusti V, Heraief E, et al. Laparoscopic Roux-en-Y gastric bypass: initial 2-year experience. Surg Endosc. 2003;17:603–9.PubMedCrossRef
10.
go back to reference Wittgrove AC, Clark GW, Tremblay LJ. Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg. 1994;4:353–7.PubMedCrossRef Wittgrove AC, Clark GW, Tremblay LJ. Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg. 1994;4:353–7.PubMedCrossRef
11.
go back to reference Schauer P, Ikramuddin S, Hamad G, et al. The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases. Surg Endosc. 2003;17:212–5.CrossRef Schauer P, Ikramuddin S, Hamad G, et al. The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases. Surg Endosc. 2003;17:212–5.CrossRef
12.
13.
14.
go back to reference Lee WJ, Huang MT, Yu PJ, et al. Laparoscopic vertical banded gastroplasty and laparoscopic gastric bypass: a comparison. Obes Surg. 2004;14:626–34.PubMedCrossRef Lee WJ, Huang MT, Yu PJ, et al. Laparoscopic vertical banded gastroplasty and laparoscopic gastric bypass: a comparison. Obes Surg. 2004;14:626–34.PubMedCrossRef
15.
go back to reference Lee WJ, Yu PJ, Wang W, et al. Laparoscopic Roux-en-Y versus minigastric bypass for the treatment of morbid obesity: a prospective randomized controlled clinical trial. Ann Surg. 2005;242:20–8.PubMedCrossRef Lee WJ, Yu PJ, Wang W, et al. Laparoscopic Roux-en-Y versus minigastric bypass for the treatment of morbid obesity: a prospective randomized controlled clinical trial. Ann Surg. 2005;242:20–8.PubMedCrossRef
16.
go back to reference Oliak D, Ballantyne GH, Weber P, et al. Laparoscopic Roux-en-Y gastric bypass: defining the learning curve. Surg Endosc. 2003;17:405–8.PubMedCrossRef Oliak D, Ballantyne GH, Weber P, et al. Laparoscopic Roux-en-Y gastric bypass: defining the learning curve. Surg Endosc. 2003;17:405–8.PubMedCrossRef
17.
go back to reference Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg. 2000;232:515–29.PubMedCrossRef Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg. 2000;232:515–29.PubMedCrossRef
18.
go back to reference Higa KD, Boone KB, Ho T, et al. Laparoscopic Roux-en-Y gastric bypass for morbid obesity: technique and preliminary results of our first 400 patients. Arch Surg. 2000;135:1029–33.PubMedCrossRef Higa KD, Boone KB, Ho T, et al. Laparoscopic Roux-en-Y gastric bypass for morbid obesity: technique and preliminary results of our first 400 patients. Arch Surg. 2000;135:1029–33.PubMedCrossRef
19.
go back to reference Higa KD, Boone KB, Ho T. Complications of the laparoscopic Roux-en-Y gastric bypass: 1040 patients—what have we learned? Obes Surg. 2000;10:509–13.PubMedCrossRef Higa KD, Boone KB, Ho T. Complications of the laparoscopic Roux-en-Y gastric bypass: 1040 patients—what have we learned? Obes Surg. 2000;10:509–13.PubMedCrossRef
20.
go back to reference Perugini RA, Mason R, Czerniach DR, et al. Predictors of complication and suboptimal weight loss after laparoscopic Roux-en-Y gastric bypass: a series of 188 patients. Arch Surg. 2003;138:541–5.PubMedCrossRef Perugini RA, Mason R, Czerniach DR, et al. Predictors of complication and suboptimal weight loss after laparoscopic Roux-en-Y gastric bypass: a series of 188 patients. Arch Surg. 2003;138:541–5.PubMedCrossRef
21.
go back to reference O'Rourke RW, Andrus J, Diggs BS, et al. Perioperative morbidity associated with bariatric surgery: an academic center experience. Arch Surg. 2006;141:262–8.PubMedCrossRef O'Rourke RW, Andrus J, Diggs BS, et al. Perioperative morbidity associated with bariatric surgery: an academic center experience. Arch Surg. 2006;141:262–8.PubMedCrossRef
22.
go back to reference Suter M, Paroz A, Calmes JM, et al. European experience with laparoscopic Roux-en-Y gastric bypass in 466 obese patients. Br J Surg. 2006;93:726–32.PubMedCrossRef Suter M, Paroz A, Calmes JM, et al. European experience with laparoscopic Roux-en-Y gastric bypass in 466 obese patients. Br J Surg. 2006;93:726–32.PubMedCrossRef
23.
go back to reference Papasavas PK, Caushaj PF, McCormick JT, et al. Laparoscopic management of complications following laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc. 2003;17:610–4.PubMedCrossRef Papasavas PK, Caushaj PF, McCormick JT, et al. Laparoscopic management of complications following laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc. 2003;17:610–4.PubMedCrossRef
24.
go back to reference Nguyen NT, Stevens CM, Wolfe BM. Incidence and outcome of anastomotic stricture after laparoscopic gastric bypass. J Gastrointest Surg. 2003;7:997–1003.PubMedCrossRef Nguyen NT, Stevens CM, Wolfe BM. Incidence and outcome of anastomotic stricture after laparoscopic gastric bypass. J Gastrointest Surg. 2003;7:997–1003.PubMedCrossRef
25.
go back to reference Consensus Development Conference Panel. Gastrointestinal surgery for severe obesity: consensus development conference statement. Ann Intern Med. 1991;115:956–61. Consensus Development Conference Panel. Gastrointestinal surgery for severe obesity: consensus development conference statement. Ann Intern Med. 1991;115:956–61.
26.
go back to reference Catalano MF, Chua TY, Rudic G. Endoscopic balloon dilation of stomal steno-sis following gastric bypass. Obes Surg. 2007;17:298–303.PubMedCrossRef Catalano MF, Chua TY, Rudic G. Endoscopic balloon dilation of stomal steno-sis following gastric bypass. Obes Surg. 2007;17:298–303.PubMedCrossRef
27.
go back to reference Muller MK, Wildi S, Scholz T, et al. Laparoscopic pouch resizing and redo of gastro-jejunal anastomosis for pouch dilatation following gastric bypass. Obes Surg. 2005;15:1089–95.PubMedCrossRef Muller MK, Wildi S, Scholz T, et al. Laparoscopic pouch resizing and redo of gastro-jejunal anastomosis for pouch dilatation following gastric bypass. Obes Surg. 2005;15:1089–95.PubMedCrossRef
Metadata
Title
Laparoscopic Roux-en-Y Gastric Bypass for Morbidly Obese Chinese Patients: Learning Curve, Advocacy and Complications
Authors
Chih-Kun Huang
Yi-Chia Lee
Chao-Ming Hung
Yaw-Sen Chen
Chi-Ming Tai
Publication date
01-07-2008
Publisher
Springer-Verlag
Published in
Obesity Surgery / Issue 7/2008
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-007-9373-y

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