Laparoscopic Roux-en-Y gastric bypass for morbid obesity

Introduction: The introduction of the laparoscopic approach to bariatric surgery brought similar advantages as seen in general surgery. Randomized trials confirm greater long-term weight loss after Roux-en-Y gastric bypass (RYGBP) than after vertical banded gastroplasty (VBG). In order to get similar results, the authors introduced this technique. This report is to present our preliminary experience of laparoscopic Roux-en-Y gastric bypass (LRYGBP). Materials and Methods: From December 2000 to March 2002, 21 consecutive patients (3 male, 18 female) underwent LRYGBP. The mean age was 31.7 years old (18-54); and the mean BMI was 43.1 Kg/m² (40-52). Three patients had a previous laparoscopic vertical banded gastroplasty (LVBG) with failure of weight loss. The procedure was performed under reverse Trendlengburg position using the five-trocar method; with the operative procedures of 15 to 20 ml isolated gastric pouch using multiple Endo-GIA II staplers; division of proximal jejunum at 50 cm from ligament of Treitz; retrocolic and retrogastric Roux limb (100cm Roux limb for BMI under 50, 150cm Roux limb for over 50) with end-to-side gastrojejunal anastomosis using a 21mm cEEA stapler. Patients were followed for weight loss every three months, and the results were retrospectively compared with that of LVBG reported previously in our series. Results: All procedures were completed laparoscopically except one patient (4.7%), who was converted to laparotomy due to severe adhesion caused by previous VBG. The mean operative time was 209(175-295) minutes. Four patients (19%) had major postoperative complication of leakage and were successfully treated with drainage and total parental nutrition supplement. Postoperative mean hospital stay was 6.5 days. The weight reduction of excess body weight was 68.7% with mean BMI 28.6 kg/m² 9 months after the operation. The complication rate of LRYGBP was much higher than that of LVBG. However, the decrease in body weight and quality of life seems better than previous experience of LVBG. Conclusion: LRYGBP is an advanced procedure requiring a steep learning curve. The present preliminary experience confirms that LRYGBP induces a rapid control of morbid obesity, but a special caution must be paid to the complication of leakage.