Laparoscopic Roux-en-Y gastric bypass for morbid obesity - Technique and preliminary results of our first 400 patients

Hypothesis: A technique of the laparoscopic Roux-en-Y gastric bypass can be developed that is safe, effective, and practical in the community setting. Design: A case series of 400 morbidly obese and super-obese individuals who underwent the laparoscopic Roux-en-Y gastric bypass over a 22-month period. Setting: Community private practice in Fresno, Calif. Patients: A consecutive sample of 400 patients (70 males and 330 females) who met National Institutes of Health criteria for recommendation of a bariatric procedure. Only patients who had a previous gastric or bariatric procedure were excluded from this sample. Intervention: Laparoscopic Roux-en-Y gastric bypass with a hand-sewn gastrojejunal anastomosis. Main Outcome Measures: Weight loss, complications, length of hospital stay, successful completion of the operation, and operative times were measured. Results: Open conversion was required in 12 patients (6 males and 6 females) and a secondary operation for incomplete division of the stomach was required in 2 patients early in the case series. Alternative exposure and fixation techniques greatly reduced these occurrences. There were 6 staple-line failures owing to a change in the manufacture of the instrument. There were no leaks at the gastrojejunal anastomosis, but 21 patients required endoscopic balloon dilation for significant stenosis. The average hospital stay was 1.6 days for the patients who underwent laparoscopy and 2.7 days for patients requiring open conversion. Average excessive weight loss was 69% at 12 months. Operative times are between 60 and 90 minutes. Other complications are described. Conclusion: The Roux-en-Y gastric bypass can be safely and effectively performed in the community setting using advanced laparoscopic techniques.