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) w ho met National Institutes of Health criteria for recommendation of a baria tric procedure. Only patients who had a previous gastric or bariatric proce dure were excluded from this sample. Intervention: Laparoscopic Roux-en-Y gastric bypass with a hand-sewn gastro jejunal 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 requ ired in 2 patients early in the case series. Alternative exposure and fixat ion 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 endosc opic balloon dilation for significant stenosis. The average hospital stay w as 1.6 days for the patients who underwent laparoscopy and 2.7 days for pat ients requiring open conversion. Average excessive weight loss was 69% at 1 2 months. Operative times are between 60 and 90 minutes. Other complication s are described. Conclusion: The Roux-en-Y gastric bypass can be safely and effectively perf ormed in the community setting using advanced laparoscopic techniques.