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Erschienen in:
01.01.2010 | Clinical Research
Non-transectional Open Gastric Bypass as the Definitive Bariatric Procedure for 61 Patients with BMI of 70 and Higher
Erschienen in: Obesity Surgery | Ausgabe 1/2010
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Background
Technical difficulties in laparoscopic gastric bypass for severely obese patients have led to sleeve gastrectomy first and then laparoscopic gastric bypass as a second stage after significant weight loss. Rather than commit these fragile patients to two operations, we have done open gastric bypass as a definitive surgical treatment for extreme obesity.
Methods
Office records of 61 patients with body mass index (BMI) of 70 and higher were reviewed. All underwent non-transectional open gastric bypass with a 150 cm Roux limb. Data included age, sex, weight, BMI, co-morbidities, operative information, length of stay (LOS), surgical morbidity, and percent excess weight loss (%XSWL). Data are in median (range).
Results
There were 21 (34%) men and 40 (66%) women: age, 37 years (19–53); pre-operative weight, 468 lb (300–650); and pre-operative BMI, 77 (70–95). Co-morbidities were diabetes mellitus, 26 (46%); hypertension, 26 (43%); sleep apnea, 61 (100%); gastroesophageal reflux disease, 20 (33%); and hypothyroid nine (15%). Incision length was 15 cm (12–20), abdominal wall fat thickness was 8 cm (5–13), operative time was 150 min (100–210), and estimated blood loss was 100 ml (25–750); post-op intensive care unit: yes 16 (26%) and no 44 (74%). LOS was 3 days for 44 patients (74%), 4 days for 11 (18%), 5 days for five (8%), and 7 days for one (1.6%). Post-operative morbidity was as follows: zero mortality, splenectomy, stoma leak, deep venous thrombosis, pulmonary embolus, GI bleeding, stomal ulcer, intestinal obstruction, fascial dehiscence, or 30-day readmission; wound infections in one (1.6%); skin wound separation in six (10%); pneumonia in one (1.6%); anemia in nine (14.8%); vitamin B12 deficiency in six (10%); incisional hernia in 17 (28%); and gastric staple line disruption in two (3.3%). %XSWL were 51% in 1 year (28–84) and 60% in 2 years (27–97).
Conclusions
Non-transectional open gastric bypass for patients with BMI of 70 and higher is safe and effective as a one-stage operation for severe obesity.