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Obesity Surgery
Published in: Obesity Surgery 7/2012

01-07-2012 | Other

Perioperative Morbi-mortality Associated with Bariatric Surgery: from Systematic Biliopancreatic Diversion to A Tailored Laparoscopic Gastric Bypass or Sleeve Gastrectomy Approach

Authors: Manuel de la Matta-Martín, Jesús Acosta-Martínez, Salvador Morales-Conde, Augusto Herrera-González

Published in: Obesity Surgery | Issue 7/2012

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Abstract

Background

The effectiveness and safety of the different bariatric surgical procedures currently available depend, partly, on the characteristics of the populations under study, the technical approach, the expertise of surgical teams, and on institutional factors. To evaluate the effectiveness and safety of these procedures, we compared the surgical results for biliopancreatic diversion surgery versus laparoscopic gastric bypass and sleeve gastrectomies performed in our institution.

Methods

This was a retrospective observational study of 296 patients undergoing bariatric surgery from January 2005 through October 2010. We analyzed mortality rate, cardiocirculatory and pulmonary perioperative complications, duration of surgery, intensive care unit admissions, and length of stay. We describe the changes in the choice of the surgical procedures throughout the study period.

Results

We observed a rate of pulmonary complications of 2.3 % and a mortality rate 3 months after discharge of 2.36 % with sepsis secondary to anastomotic leak as the main cause of death. Biliopancreatic diversion surgery was associated with higher mortality rates (p value = 0.014) and longer hospital stay (median of 9 versus 6 days for laparoscopic gastric bypass and sleeve gastrectomy, p value <0.001). Body mass index ≥50 was also related to higher mortality (p value = 0.023). We confirmed a progressive increase in laparoscopic restrictive and mixed techniques in our institution (from 0 % in 2005 to 87 % of all procedures in 2010).

Conclusions

Bariatric surgery in our institution has dramatically shifted from systematic biliopancreatic diversion to a tailored laparoscopic gastric bypass or sleeve gastrectomy approach, which has made it possible to reduce hospital stay and mortality rates.
Appendix
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Literature
1.
Colquitt JL, Picot J, Loveman E, et al. Cirugía para la obesidad (Revision Cochrane traducida). In: Biblioteca Cochrane Plus 2009 Número 4. Oxford: Update Software Ltd.URL: http://​www.​update-software.​com. (translated from The Cochrane Library, 2009 Issue 2 Art no. CD003641. Chichester: Wiley).
2.
Morales-Conde S, Socas-Macías M, Barranco-Moreno A. Técnicas quirúrgicas en la cirugía bariátrica. Abordaje laparoscópico. In: Serra-Gómez C, editor. El paciente con obesidad: implicaciones perioperatorias. Madrid: EMISA; 2009. p. 249–71.
3.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRef
4.
Sauerland S, Angrisani L, Belachew M, et al. Obesity surgery: evidence-based guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc. 2005;19:200–21.PubMedCrossRef
5.
Blackburn GL, Hutter MM, Harvey AM, et al. Expert panel on weight loss surgery: executive report update. Obesity. 2009;17:842–62.PubMedCrossRef
6.
Buchwald H, Estok R, Farhbach K, et al. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery. 2007;142:621–35.PubMedCrossRef
7.
Licker M, Schweizer A, Ellenberger C, et al. Perioperative medical management of patients with COPD. Int J COPD. 2007;2:493–515.
8.
Myles PS, Iacono GA, Hunt JO, et al. Risk of respiratory complication and wound infection in patients undergoing ambulatory surgery. Anesthesiology. 2002;97:842–7.PubMedCrossRef
9.
Warner DO, Warner MA, Offord KP, et al. Airway obstruction and perioperative complications in smokers undergoing abdominal surgery. Anesthesiology. 1999;90:372–9.PubMedCrossRef
10.
Flum DR, Salem L, Broeckel JA, et al. Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures. JAMA. 2005;294:1903–8.PubMedCrossRef
11.
Kohn GP, Galanko JA, Overby DW, et al. High case volumes and surgical fellowships are associated with improved outcomes for bariatric surgery patients: a justification of current credentialing initiatives for practice and training. J Am Coll Surg. 2010;210:909–18.PubMedCrossRef
12.
Belle SH, Berk PD, Courcoulas AP, et al. Safety and efficacy of bariatric surgery: longitudinal assessment of bariatric surgery. Surg Obes Relat Dis. 2007;3:116–26.PubMedCrossRef
13.
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;234:279–91.PubMedCrossRef
14.
Navarro-Martínez MJ, Pindado-Martínez ML, Paz-Martín D, et al. Tratamiento anestésico perioperatorio de 300 pacientes con obesidad mórbida sometidos a cirugía bariátrica laparoscópica y breve revisión fisiopatológica. Rev Esp Anest Reanim. 2011;58:211–7.
15.
Weller WE, Rosati C. Comparing outcomes of laparoscopic versus open bariatric surgery. Ann Surg. 2008;248:10–5.PubMedCrossRef
16.
Hutter MM, Randall S, Khuri SF, et al. Laparoscopic versus open gastric bypass for morbid obesity. A multicenter, prospective, risk-adjusted analysis from the National Surgical Quality Improvement Program. Ann Surg. 2006;243:657–66.PubMedCrossRef
17.
Topart P, Becouarn G, Ritz P. Biliopancreatic diversion with duodenal switch or gastric bypass for failed gastric banding: retrospective study from two institutions with preliminary results. Surg Obes Relat Dis. 2007;3:521–5.PubMedCrossRef
18.
19.
Jones Jr KB, Afram JB, 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 reported series. Obes Surg. 2006;16:721–7.PubMedCrossRef
20.
Jones Jr KB. Are we pricing ourselves out of the market in bariatric surgery? Obes Surg. 2011;21:928–9.PubMedCrossRef
21.
22.
Elder KA, Wolfe BM. Bariatric surgery: a review of procedures and outcomes. Gastroenterology. 2007;132:2253–71.PubMedCrossRef
23.
Metadata
Title
Perioperative Morbi-mortality Associated with Bariatric Surgery: from Systematic Biliopancreatic Diversion to A Tailored Laparoscopic Gastric Bypass or Sleeve Gastrectomy Approach
Authors
Manuel de la Matta-Martín
Jesús Acosta-Martínez
Salvador Morales-Conde
Augusto Herrera-González
Publication date
01-07-2012
Publisher
Springer-Verlag
Published in
Obesity Surgery / Issue 7/2012
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-012-0653-9

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