Evolution of minimally invasive bariatric surgery

Background. Minimally invasive Roux-en-Y gastric bypass is a procedure that is being performed with increasing frequency. It is an advanced laparoscopic procedure with a steep learning curve. With experience, it can be performed in a reasonable amount of time with minimal morbidity. Methods. We firs...

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Bibliographic Details
Published in:Surgery 2002-10, Vol.132 (4), p.565-572
Main Authors: Gould, Jon C., Needleman, Bradley J., Ellison, E.Christopher, Muscarella, Peter, Schneider, Carol, Melvin, W.Scott
Format: Article
Language:English
Subjects:
Adult
Anastomosis, Roux-en-Y - methods
Anastomosis, Roux-en-Y - trends
Gastric Bypass - methods
Gastric Bypass - trends
Humans
Laparoscopy - methods
Laparoscopy - trends
Length of Stay
Middle Aged
Minimally Invasive Surgical Procedures - methods
Minimally Invasive Surgical Procedures - trends
Postoperative Complications - classification
Reoperation
Retrospective Studies
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Summary:Background. Minimally invasive Roux-en-Y gastric bypass is a procedure that is being performed with increasing frequency. It is an advanced laparoscopic procedure with a steep learning curve. With experience, it can be performed in a reasonable amount of time with minimal morbidity. Methods. We first performed minimally invasive gastric bypass with the hand-assisted laparoscopic surgery (HALS) technique. After significant experience with HALS, we changed our approach to completely laparoscopic (LS). Our technique for all cases involves a circular stapled gastrojejunostomy with a 25-mm anvil passed transgastrically. Results. From June 1998 to January 2002, 304 patients underwent minimally invasive gastric bypass. Our first 81 cases were with HALS, and the rest were LS. The incidence of early major and minor perioperative complications for the entire series was 5.6% and 7.9%, respectively. Early reoperation (less than 30 days) was required in 4.6% of all patients. There was 1 leak (1.2%) in the HALS group and 4 anastomotic leaks (1.8%) in the LS group. Other measured outcomes were similar in each group with the exception of wound hernia (16% HALS vs 0.9% LS). Weight loss after 1 year was 44% for HALS and 56% for LS. We have not had any deaths in our series. Conclusions. HALS may have certain advantages in selected patients and early in a surgeon's experience with minimally invasive gastric bypass. With experience, good results are possible with either approach. (Surgery 2002;132:565-72.)
ISSN:0039-6060
1532-7361
DOI:10.1067/msy.2002.127554