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Laparoscopic Roux-en-Y gastric bypass: results and learning curve of a high-volume academic program
Scott A Shikora1, Julie J Kim, Michael E Tarnoff
1Division of Bariatric Surgery, Department of Surgery, Tufts-New England Medical Center, Boston, MA, USA.
Hypothesis:
Laparoscopic Roux-en-Y gastric bypass is a complex procedure performed on a high-risk patient population. Good results can be attained with experience and volume.
Design:
Retrospective study.
Setting:
Tertiary care academic hospital.
Patients:
Seven hundred fifty consecutive morbidly obese patients undergoing surgery from March 1998 to April 2004.
Interventions:
All patients underwent laparoscopic Roux-en-Y gastric bypass.
Main Outcome Measures:
Perioperative deaths and complications.
Results:
The patient population was 85% women and had a mean body mass index of 47 kg/m2 (range, 32-86 kg/m2). The overall complication rate was 15% and the mortality was 0.3%. For the first 100 cases, the overall complication rate was 26% with a mortality of 1%. This complication rate decreased to approximately 13% and was stable for the next 650 patients. The incidence of major complications has also decreased since the first 100 cases. Leak decreased from 3% to 1.1%. Small-bowel obstruction decreased from 5% to 1.1%. Overall mean operating time was 138 minutes (range, 65-310 minutes). It decreased from 212 minutes for the first 100 cases to 132 minutes for the next 650 and 105 minutes (range, 65-200 minutes) for the last 100 cases.
Conclusions:
Laparoscopic Roux-en-Y gastric bypass is a technically difficult operation. This review of a large series in a high-volume program demonstrated that the morbidity and mortality could be reduced by 50% with experience. The results are similar to those reported from other major centers. In addition, as reported elsewhere, the learning curve for this procedure may be 100 cases.
