RESUMEN
BACKGROUND: Proximal Roux-en-Y gastric bypass may not ensure adequate weight loss in superobese patients. Bypassing a longer segment of the small bowel may increase weight loss. The objective of the study was to compare the perioperative outcomes of laparoscopic proximal and distal gastric bypass in a double-blind randomized controlled trial of superobese patients. The study was conducted at two public tertiary care obesity centers in Norway. METHODS: Patients with body mass index (BMI) 50-60 kg/m(2) were randomly assigned to a proximal (150 cm alimentary limb) or a distal (150 cm common channel) gastric bypass. The biliopancreatic limb was 50 cm in both operations. Patients and follow-up personnel were blinded to the type of procedure. Thirty-day outcomes including complications are reported. RESULTS: We operated on 115 patients, of whom two were excluded at surgery, leaving 56 and 57 patients in the proximal group and distal group, respectively. The median (range) operating time was 72 (36-151) and 101 (59-227) min, respectively (p < 0.001). Two distal procedures were converted to laparotomy during the primary procedure. Median length of hospital stay was 2 (1-4) days in the proximal group and 2 (1-24) days in the distal group. The number of patients with complications and complications categorized according to the Contracted Accordion classification did not differ significantly. However, all six reoperations were performed in the distal group, of which three were completed by laparoscopy (p = 0.01 between groups). There were no deaths. CONCLUSIONS: In superobese patients with BMI between 50 and 60 kg/m(2), distal gastric bypass was associated with longer operating time and more severe complications resulting in reoperation than proximal gastric bypass.
Asunto(s)
Derivación Gástrica/métodos , Obesidad Mórbida/cirugía , Adulto , Índice de Masa Corporal , Método Doble Ciego , Femenino , Derivación Gástrica/efectos adversos , Derivación Gástrica/estadística & datos numéricos , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Noruega/epidemiología , Obesidad Mórbida/diagnóstico , Obesidad Mórbida/epidemiología , Tempo Operativo , Periodo Perioperatorio , Reoperación/estadística & datos numéricos , Resultado del Tratamiento , Pérdida de Peso/fisiologíaRESUMEN
BACKGROUND: Acute jejunojejunostomy (JJ) obstruction after laparoscopic gastric bypass secondary to the formation of an intraluminal blood clot is a rare event. We analyzed our experience with such complications from a large consecutive patient series at a university hospital that is a referral center for bariatric surgery. METHODS: A retrospective review of patient data in a register of all patients who had undergone gastric bypass from June 2004 to March 2011 was performed. Reoperations were analyzed for the cause and findings. The patients received routine postoperative administration of low-molecular-weight heparin. RESULTS: Of 1066 patients, 5 (.5%; 4 women and 1 man), who had undergone laparoscopic gastric bypass, with a median body mass index of 42 kg/m(2) (range 40-46), underwent reoperation for obstruction of the JJ secondary to a blood clot. The indications for reoperation were signs of bleeding, nausea, or findings on abdominal computed tomography. The time of reoperation was 1, 1, 2, 3, and 11 days after the primary procedure. All patients underwent reoperation by laparoscopy, with evacuation of the blood clot through an opening of the suture or staple lines without additional revision of the JJ. The gastric remnant was decompressed using a percutaneously placed gastrostomy tube. One patient had gastric leakage from the staple lines (blowout) that necessitated several later revisions for subcutaneous abscesses. Another patient developed acute pancreatitis. CONCLUSION: Blood clots can cause early obstruction of the JJ after gastric bypass. Awareness of this potentially rapidly progressive and life-threatening complication will allow immediate intervention and reduce the risk of serious sequelae.
Asunto(s)
Derivación Gástrica/efectos adversos , Obstrucción Intestinal/etiología , Enfermedades del Yeyuno/etiología , Yeyunostomía/efectos adversos , Laparoscopía/efectos adversos , Trombosis/etiología , Adulto , Femenino , Humanos , Obstrucción Intestinal/cirugía , Enfermedades del Yeyuno/cirugía , Masculino , Persona de Mediana Edad , Hemorragia Posoperatoria/etiología , Reoperación , Dehiscencia de la Herida Operatoria/etiologíaRESUMEN
BACKGROUND: Biliopancreatic diversion with duodenal switch is used in the treatment of morbid obesity. Few centres perform the procedure laparoscopically. We aimed to evaluate the perioperative outcomes and weight loss after laparoscopic duodenal switch. MATERIAL AND METHODS: All patients operated with biliopancreatic diversion with duodenal switch at the Centre for Morbid Obesity at Oslo University Hospital (2004-2009) were included. The perioperative period was defined as within 30 days of surgery. RESULTS: A total of 48 patients were operated, all laparoscopically. Median preoperative BMI was 54 kg/m2 (range 41-88), and 33 patients (69 %) were women. Ten patients (21 %) were operated in two steps: first gastric sleeve and later duodenal switch. Median operation time was 200 minutes (100-658). Twelve patients (25 %) had complications, four (8 %) were reoperated, and one died. Median postoperative hospital stay was three (1-56) days. After two years, median BMI was 32 kg/m2 (24-45), median weight loss 39 % (22-60) and median excess BMI (> 25 kg/m2) loss 73 % (43-106). INTERPRETATION: Duodenal switch was applied in a minority of patients operated for morbid obesity. The procedure can be performed laparoscopically with a short hospital stay and leads to a substantial weight loss. Perioperative morbidity was high and was comparable to the results from other series.
Asunto(s)
Desviación Biliopancreática/métodos , Duodeno/cirugía , Laparoscopía/métodos , Obesidad Mórbida/cirugía , Adolescente , Adulto , Desviación Biliopancreática/efectos adversos , Índice de Masa Corporal , Femenino , Estudios de Seguimiento , Humanos , Laparoscopía/efectos adversos , Masculino , Persona de Mediana Edad , Obesidad Mórbida/complicaciones , Reoperación , Resultado del Tratamiento , Pérdida de Peso , Adulto JovenRESUMEN
BACKGROUND: Overweight and obesity are associated with an increased risk of acquiring type 2 diabetes and metabolic syndrome. We have assessed the prevalence of these conditions before and after gastric bypass surgery for morbid obesity. MATERIAL AND METHODS: The patients included had undergone laparoscopic gastric bypass at Oslo University Hospital Aker in the period 01.01.2007 - 31.12.2007 and had follow-up data for more than six months. Type 2 diabetes was defined as one or more of the following: an established diagnosis of diabetes before surgery, fasting plasma glucose >or= 7.0 mmol/l or HbA1c >or= 6.5 %. The metabolic syndrome was defined according to criteria laid out by the National Cholesterol Education Program. RESULTS: 136 patients (79 % women) with a mean (+/- SD) age of 43 +/- 9 years were included. Mean follow-up time was 17 months (range 8 - 26). The patients' body mass index (kg/m2) was reduced from 47 +/- 6 before to 32 +/- 6 after surgery (p<0.001). 34 % of patients had type 2 diabetes before and 10 % after surgery (p < 0.001). 80 % of patients had metabolic syndrome before and 24 % after surgery (p < 0.001). Fasting plasma glucose, HbA1c, and all variables included in the definition of metabolic syndrome were statistically significantly improved after surgery. INTERPRETATION: Gastric bypass has favourable effects on type 2 diabetes. Blood glucose normalised in most patients after the operation. The prevalence of metabolic syndrome was significantly lower after surgery.
Asunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Derivación Gástrica , Síndrome Metabólico/etiología , Obesidad Mórbida/cirugía , Adulto , Diabetes Mellitus Tipo 2/sangre , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Obesidad Mórbida/complicaciones , Estudios RetrospectivosRESUMEN
BACKGROUND: Bariatric surgery was established at several Norwegian hospitals in 2004. This study evaluates the perioperative outcome and the learning curves for two surgeons while introducing laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS: Morbidly obese patients undergoing primary LRYGB were included. Lengths of surgery and postoperative hospital stay, and 30-day rates of morbidity, reoperations, and readmissions were set as indicators of the learning curve. Learning effects were evaluated by graphical analyses and comparing the first and last 40 procedures for both surgeons. RESULTS: The 292 included patients had a mean age of 40.0 +/- 9.5 years and a mean body mass index (BMI) of 46.7 +/- 5.3 kg/m(2). The mean length of surgery was 101 +/- 55 min. Complications occurred in 43 patients (14.7%), with no conversions to open surgery in the primary procedure and no mortality. Reoperations were performed in 14 patients (4.8%), of which five patients required open surgery. The median length of stay was 3 days (range 1-77), and 19 patients (6.5%) were readmitted. High patient age, but not high BMI, was associated with an increased risk of complication. For both surgeons, lengths of surgery and hospital stay were significantly reduced (p < 0.001), leveling out after 100 procedures. Reductions in the rates of morbidity, reoperations and readmissions were not found. CONCLUSION: LRYGB was introduced with an acceptable morbidity rate and no mortality. Only the length of surgery and postoperative hospital stay were suitable indicators of a learning curve, which comprised about 100 cases.
Asunto(s)
Competencia Clínica , Derivación Gástrica/educación , Derivación Gástrica/métodos , Laparoscopía/efectos adversos , Obesidad Mórbida/cirugía , Adulto , Factores de Edad , Índice de Masa Corporal , Femenino , Derivación Gástrica/efectos adversos , Derivación Gástrica/estadística & datos numéricos , Humanos , Complicaciones Intraoperatorias/epidemiología , Periodo Intraoperatorio/estadística & datos numéricos , Laparoscopía/estadística & datos numéricos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Morbilidad , Noruega , Obesidad Mórbida/epidemiología , Readmisión del Paciente/estadística & datos numéricos , Atención Perioperativa/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Reoperación/estadística & datos numéricos , Factores de Riesgo , Resultado del TratamientoRESUMEN
BACKGROUND: Aker University Hospital has since 2004 offered laparoscopic surgery for morbid obesity. This study describes the characteristics of the patients undergoing surgery, the preoperative evaluation and the perioperative outcome after the first 139 laparoscopic procedures for morbid obesity. MATERIAL AND METHODS: All patients operated between June 2004 and March 2006 are included in the study. The registration of data was first retrospective, and from 2006 prospective using specially designated registration forms. RESULTS: Surgery was performed on 105 women (76%) and 33 men. The median age was 39 years (range 22-60), and the median preoperative body mass index was 47 kg/m2 (37-71). Frequent comorbidities included joint pain (44%), hypertension (31%), asthma (30%) and diabetes mellitus (27%). The patients underwent gastric bypass (86%), duodenal switch (10%) or gastric sleeve (4%). Two procedures (1%) were converted to open surgery. Perioperative morbidity (within 30 days) was 19%. The most frequent major complications were leakage from the stomach or bowel in seven patients (5%), intra-abdominal bleeding in four patients (3%) and deep infection (3%). Reoperation was performed on 13 patients (9%). One patient died following surgery (1%). INTERPRETATION: . Laparoscopic bariatric surgery has now been established at Aker University Hospital. The complication rates seem acceptable, considering the patients'comorbid conditions and the introduction of advanced laparoscopic procedures.
Asunto(s)
Cirugía Bariátrica/métodos , Obesidad Mórbida/cirugía , Adulto , Cirugía Bariátrica/efectos adversos , Índice de Masa Corporal , Competencia Clínica , Duodeno/cirugía , Femenino , Gastrectomía/efectos adversos , Gastrectomía/métodos , Derivación Gástrica/efectos adversos , Derivación Gástrica/métodos , Hospitales Universitarios , Humanos , Laparoscopía , Masculino , Persona de Mediana Edad , Obesidad Mórbida/complicaciones , Obesidad Mórbida/diagnóstico , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Reoperación , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: In 1995 we introduced laparoscopic technique as routine for fundoplication for gastro-esophageal reflux disease. MATERIAL AND METHODS: 222 patients were scheduled for laparoscopic fundoplication; the operation was completed laparoscopically in 219 patients. They all had an observation period of one year as a minimum; 205 patients returned a follow-up questionnaire. RESULTS: 12 patients had major complications, six of them have been reoperated. At follow-up, 95% reported excellent or good results, 3% had persisting reflux symptoms, 4% had moderate to severe dysphagia and 17% had moderate to severe gas bloat syndrome and flatulence problems which adversely affected an otherwise good outcome. Thus, 63% reported excellent, 23% good and 7% fair outcome, and 6% were moderately or very dissatisfied. Bloating and increased flatulence were the major reasons for dissatisfaction. INTERPRETATION: The risk of troublesome postoperative bloating and flatulence should be addressed thoroughly during the preoperative information, and especially in patients who have similar symptoms preoperatively.