Laparascopic Gastric Bypass

Experience and Results

Over 400 patients have been treated by our team between 1999 and 2003. 191 patients were recently reviewed.

Patients’ age varied between 18 and 61 years (median 36). Thirty two patients were male, 159 were female. BMI averaged 46 kg/m_ (32-75). One hundred and fifty seven patients underwent the bypass as a primary procedure, 15 patients after unsuccessful band gastroplasty, 3 after Mason VBG and 3 after Scopinaro biliopancreatic diversion. Thirteen patients benefited from a Roux en Y construction without transection of the stomach, with partitioning by an adjustable ilicone band.

Operating time was 105 minutes (55-320); blood loss averaged some 50cc. Peroperative complications included 2 conversions (case 3 and case 96). In one patient, the nasogastric tube was inadvertently sectioned by the linear stapler; the gastro enterostomy showed a defect at the immersion test in 3 patients, and he anastomosis had to be perfected with manual stitching. Small bowel perforation, requiring stitching, and caused by the use of sharp tools occurred twice. Hospital stay was 4 days (2-32).

There were no deaths. 18 patients (10 %) had to be reoperated. Fourteen of these came from the primary bypass group, 4 from the band-bypass group. In these latter patients, erosion occurred in 2 patients on the small bowel limb, just distal to the anastomosis with the gastric pouch. Two other patients requested removal of the band because of severe dyphagia. In the former group, 5 patients had to be treated by laparotomy, for 1/ undetected small bowel perforation, day 3, 2/ hemorrage at the level of the entero enterostomy, day 1, 3/ obstructed entero enterostomy, day 3, 4/ wrong construction (biliary limb anastomosed to itself, Roux en O construction), day 8 and 5/ incisional hernia after conversion (case 3, postop day 200). Nine patients were treated by laparoscopy for trocar site hernia (n=2), obstruction by bands (n=2), abscess at the stapler introduction site (n=2), obstruction at the entero enterostomy (1 patient), leak at the gastro jejunostomy (1 patient) and suspicion of peritonitis (negative reexploration, 1 patient).

7 patients had significant complications, treated conservatively. Two patients had a leak at the stomach remnant, one around a gastrostomy catheter, one at the gastro jejunostomy site after Jejuno ileal bypass; one patient developed an ulcer of the duodenum, with bleeding requiring transfusion some 6 months postoperatively; and 4 patients developed stenosis of the gastro jejunostomy, requiring between one and nine dilations (median 4). One of these latter patients developed untractable stenosis and underwent resection of the stomach pouch and esophago jejunostomy 18 months after the initial procedure.

The loss of excess body weight was as follows: at 1 year (88 patients), median 62%, at 2 years (40 patients) median 70%, at 3 years ( 12 patients) median 65%.