Evolution of minimally invasive bariatric surgery

Area of Science:

• Bariatric Surgery
• Minimally Invasive Surgery
• Laparoscopic Procedures

Background:

• Minimally invasive Roux-en-Y gastric bypass is increasingly common.
• It is an advanced laparoscopic procedure with a steep learning curve.
• Experience allows for reasonable operative times and minimal morbidity.

Purpose of the Study:

• To compare outcomes between hand-assisted laparoscopic surgery (HALS) and completely laparoscopic (LS) minimally invasive gastric bypass.
• To evaluate the learning curve and efficacy of these techniques.
• To assess complication rates, reoperation rates, and weight loss.

Main Methods:

• Comparison of HALS (first 81 cases) and LS (remaining cases) techniques in 304 patients undergoing minimally invasive gastric bypass.
• Standardized circular stapled gastrojejunostomy with a 25-mm anvil passed transgastrically for all procedures.
• Data collection on perioperative complications, reoperations, wound hernias, and weight loss at 1 year.

Main Results:

• Overall early major and minor perioperative complications were 5.6% and 7.9%, respectively.
• Early reoperation was required in 4.6% of patients; anastomotic leaks occurred in 1.2% (HALS) and 1.8% (LS).
• Wound hernia incidence was significantly lower in the LS group (0.9%) compared to HALS (16%). One-year weight loss was 56% for LS versus 44% for HALS.

Conclusions:

• Hand-assisted laparoscopic surgery (HALS) may offer advantages for selected patients or early in a surgeon's experience.
• With accumulated experience, both HALS and completely laparoscopic approaches can yield good results in minimally invasive gastric bypass.
• The completely laparoscopic approach demonstrated superior outcomes regarding wound hernia rates and weight loss.