REDUCING EARLY TECHNICAL COMPLICATIONS IN GASTRIC BYPASS-SURGERY

Background: The incidence of complications following gastric bypass su rgery has decreased markedly over the last 30 years; nevertheless, sig nificant morbidity and mortality is still associated with this procedu re. Much of the improved risk of this technique can be attributed to t he numerous modifications that have taken place in its evolution. Meth ods: We compared our series of 640 primary cases of vertical banded ga stroplasty-Roux-en-Y gastric bypass (VBG-RGB), a form of gastric bypas s, with gastric bypass series reported in the literature from 1966 to 1996. Incidences considered were those of subphrenic abscess, gastroin testinal leaks, obstruction of the excluded segment of gastrointestina l tract, splenectomy and death. Results: The overall trend during the last 30 years has been a reduction in the rate of major complications. In our series, we had one major complication, a subphrenic abscess. T his compares favorably with the incidence of major complications repor ted in the literature. Conclusions: The gastric bypass is a significan tly safer operation today than three decades ago. We believe that the relatively low complication rate of VBG-RGB results from: (1) the anat omic location of the gastric pouch; (2) the type of stapling device us ed in its construction; (3) a pouch outlet restricted by a prosthetic band rather than a narrow anastomosis; and (4) the construction of a r etrocolic, retrogastric Roux-en-Y gastrojejunal anastomosis.