Laparoscopic Roux-en-Y gastric bypass with 2-metre long biliopancreatic limb for morbid obesity: technique and experience with the first 150 patients

2.50
Hdl Handle:
http://hdl.handle.net/2336/2687
Title:
Laparoscopic Roux-en-Y gastric bypass with 2-metre long biliopancreatic limb for morbid obesity: technique and experience with the first 150 patients
Authors:
Leifsson, Bjorn Geir; Gislason, Hjortur Georg
Citation:
Obes Surg 2005, 15(1):35-42
Issue Date:
1-Jan-2005
Abstract:
BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (RYGBP) is being performed widely as a treatment of choice for morbid obesity. We present our method and experience with the first 150 consecutive cases of laparoscopic RYGBP with a 2-m long biliopancreatic limb (BP-limb). METHODS: Between November 2001 and November 2003, a prospective analysis of 150 patients was performed identifying technical success and complications. Before surgery, patients underwent a strict multidisciplinary behavioral program. At operation the stomach was transected proximally with a linear stapler (60-mm, Endo-GIA) to create a prolongation of the esophagus (gastric tube) along the lesser curvature, resulting in a 40-50 ml pouch. Two meters of the proximal jejunum were bypassed (BP-limb), creating an antecolic Roux-en-Y gastro-jejunostomy to the posterior wall of the gastric tube using a 45-mm linear Endo-GIA stapler. The entero-anastomosis was created 50 cm below the gastro-jejunostomy, also with a 45-mm linear Endo-GIA. RESULTS: Mean BMI was 50.0, and 78% of patients were females. With 100% follow-up, we found an EWL of 50% 6 months after surgery, gradually rising to 80% after 18 months. The mean operating time was 116 min for the first 50 cases and decreased to 82 min for the last 50 cases. Intestinal leakage occurred in 5 patients (3%) and bleeding in 5 (3%). Most of these complications occurred in the first 50 cases, and all but one were treated successfully with an early laparoscopic re-operation. Marginal ulcers were found in 16.6% of patients. No internal hernias have occurred. CONCLUSION: The operation demands advanced laparoscopic skills, but technically it is relatively simple and has an acceptable complication rate. Short-term results regarding excess weight loss are at least comparable to the RYGBP with a long alimentary limb.
Description:
To access publisher full text version of this article. Please click on the hyperlink in Additional Link field
Additional Links:
http://www.ingentaconnect.com/content/klu/os/2005/00000015/00000001/art00005

Full metadata record

DC FieldValue Language
dc.contributor.authorLeifsson, Bjorn Geir-
dc.contributor.authorGislason, Hjortur Georg-
dc.date.accessioned2006-05-16T12:13:50Z-
dc.date.available2006-05-16T12:13:50Z-
dc.date.issued2005-01-01-
dc.identifier.citationObes Surg 2005, 15(1):35-42en
dc.identifier.issn0960-8923-
dc.identifier.pmid15760497-
dc.identifier.otherSAG12en
dc.identifier.urihttp://hdl.handle.net/2336/2687-
dc.descriptionTo access publisher full text version of this article. Please click on the hyperlink in Additional Link fielden
dc.description.abstractBACKGROUND: Laparoscopic Roux-en-Y gastric bypass (RYGBP) is being performed widely as a treatment of choice for morbid obesity. We present our method and experience with the first 150 consecutive cases of laparoscopic RYGBP with a 2-m long biliopancreatic limb (BP-limb). METHODS: Between November 2001 and November 2003, a prospective analysis of 150 patients was performed identifying technical success and complications. Before surgery, patients underwent a strict multidisciplinary behavioral program. At operation the stomach was transected proximally with a linear stapler (60-mm, Endo-GIA) to create a prolongation of the esophagus (gastric tube) along the lesser curvature, resulting in a 40-50 ml pouch. Two meters of the proximal jejunum were bypassed (BP-limb), creating an antecolic Roux-en-Y gastro-jejunostomy to the posterior wall of the gastric tube using a 45-mm linear Endo-GIA stapler. The entero-anastomosis was created 50 cm below the gastro-jejunostomy, also with a 45-mm linear Endo-GIA. RESULTS: Mean BMI was 50.0, and 78% of patients were females. With 100% follow-up, we found an EWL of 50% 6 months after surgery, gradually rising to 80% after 18 months. The mean operating time was 116 min for the first 50 cases and decreased to 82 min for the last 50 cases. Intestinal leakage occurred in 5 patients (3%) and bleeding in 5 (3%). Most of these complications occurred in the first 50 cases, and all but one were treated successfully with an early laparoscopic re-operation. Marginal ulcers were found in 16.6% of patients. No internal hernias have occurred. CONCLUSION: The operation demands advanced laparoscopic skills, but technically it is relatively simple and has an acceptable complication rate. Short-term results regarding excess weight loss are at least comparable to the RYGBP with a long alimentary limb.en
dc.language.isoenen
dc.publisherFD-Communications, Inc.,en
dc.relation.urlhttp://www.ingentaconnect.com/content/klu/os/2005/00000015/00000001/art00005en
dc.subjectBiliopancreatic Diversionen
dc.subjectGastric Bypassen
dc.subjectLaparoscopyen
dc.subjectObesity, Morbiden
dc.subjectAnastomosis, Roux-en-Yen
dc.subjectCombined Modality Therapyen
dc.subjectSuturesen
dc.subjectSeverity of Illness Indexen
dc.subjectRisk Assessmenten
dc.subjectWeight Lossen
dc.subjectPostoperative Complicationsen
dc.subjectTreatment Outcomeen
dc.subjectProspective Studiesen
dc.subjectAdolescenten
dc.subjectMiddle Ageden
dc.subjectComparative Studiesen
dc.subjectEvaluation Studiesen
dc.subjectHumansen
dc.subjectFemaleen
dc.subjectBody Mass Indexen
dc.subjectFollow-Up Studiesen
dc.titleLaparoscopic Roux-en-Y gastric bypass with 2-metre long biliopancreatic limb for morbid obesity: technique and experience with the first 150 patientsen
dc.typeArticleen
dc.identifier.journalObesity surgeryen
dc.format.digYES-

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