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Laparoscopic Roux en-Y Gastric Bypass Using a Modified Retrocolic–Supracolic Approach: Outcomes from 300 Patients

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Abstract

Background

Laparoscopic Roux en-Y gastric bypass (LRYGB) achieves sustained long-term weight loss and reduced mortality in morbidly obese patients. It is routinely performed using an ante- or retrocolic approach with the jejuno-jejunostomy constructed in the infracolic compartment. We have modified the standard technique of performing LRYGB by constructing both anastomoses in the supracolic compartment. This study describes the outcomes of consecutive primary LRYGB performed using this novel retrocolic–supracolic approach.

Methods

Data were prospectively collected on consecutive primary LRYGB performed in a tertiary-referral Bariatric Centre in the United Kingdom from September 2009 to March 2013. Data included demographics, operative outcomes (duration of surgery, postoperative anastomotic leak/bleeding/reoperations), development of strictures, length of stay, excess weight loss (EWL) and resolution of diabetes mellitus.

Results

Hand-sewn LRYGB was successfully performed using the retrocolic–supracolic approach in 300 of 307 (98 %) consecutive patients (72 % female). Median (IQR) age, weight and baseline body mass index were 49 (41–56) years, 146 (134–163) kg and 52.9 (48.8–57.2) kg/m2, respectively. There were 4 (1.3 %) anastomotic leaks and 8 (2.6 %) postoperative bleeds. The 30-day reoperation rate was 1.6 %. Median (IQR) hospital stay was 2 (2–2) days. Postoperative dysphagia requiring endoscopic balloon dilatation occurred in 19 (6.3 %) patients. Mean ± SD 12-month EWL was 69.9 ± 19.0 %. Within the follow-up period, 81 % of patients with type II diabetes mellitus achieved remission and 19 % reduced dosage of diabetes medication.

Conclusions

LRYGB performed using the retrocolic–supracolic approach was safe, feasible, technically advantageous and resulted in clinical outcomes akin to the standard infracolic approach.

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References

  1. Buchwald H et al (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292(14):1724–1737

    Article  CAS  PubMed  Google Scholar 

  2. Sjostrom L et al (2007) Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 357(8):741–752

    Article  PubMed  Google Scholar 

  3. Wittgrove AC, Clark GW, Tremblay LJ (1994) Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg 4(4):353–357

    Article  PubMed  Google Scholar 

  4. Higa KD et al (2000) Laparoscopic Roux-en-Y gastric bypass for morbid obesity: technique and preliminary results of our first 400 patients. Arch Surg 135(9):1029–1033 discussion 1033–1034

    Article  CAS  PubMed  Google Scholar 

  5. Schauer P, Conference ABSC (2005) Gastric bypass for severe obesity: approaches and outcomes. Surg Obes Relat Dis 1(3):297–300

    Article  PubMed  Google Scholar 

  6. Lannoo M, Dillemans B (2014) Laparoscopy for primary and secondary bariatric procedures. Best Pract Res Clin Gastroenterol 28(1):159–173

    Article  PubMed  Google Scholar 

  7. Himpens JM (2004) The gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass. Semin Laparosc Surg 11(3):171–177

    PubMed  Google Scholar 

  8. de la Torre RA, Scott JS (1999) Laparoscopic Roux-en-Y gastric bypass: a totally intra-abdominal approach–technique and preliminary report. Obes Surg 9(5):492–498

    Article  PubMed  Google Scholar 

  9. Madan AK, Harper JL, Tichansky DS (2008) Techniques of laparoscopic gastric bypass: on-line survey of American Society for Bariatric Surgery practicing surgeons. Surg Obes Relat Dis 4(2):166–172 discussion 172–173

    Article  PubMed  Google Scholar 

  10. DeMaria EJ, Portenier D, Wolfe L (2007) Obesity surgery mortality risk score: proposal for a clinically useful score to predict mortality risk in patients undergoing gastric bypass. Surg Obes Relat Dis 3(2):134–140

    Article  PubMed  Google Scholar 

  11. Ahmed J, Al-Khyatt W (2016) LRYGB: The hand-sewn technique. In: Agrawal S (ed) Obesity, bariatric and metabolic surgery. Springer, New York, pp 191–196

    Chapter  Google Scholar 

  12. Pournaras DJ et al (2010) Three hundred laparoscopic Roux-en-Y gastric bypasses: managing the learning curve in higher risk patients. Obes Surg 20(3):290–294

    Article  PubMed  Google Scholar 

  13. Abdel-Galil E, Sabry AA (2002) Laparoscopic Roux-en-Y gastric bypass–evaluation of three different techniques. Obes Surg 12(5):639–642

    Article  PubMed  Google Scholar 

  14. Gonzalez R et al (2003) Gastrojejunostomy during laparoscopic gastric bypass: analysis of 3 techniques. Arch Surg 138(2):181–184

    Article  PubMed  Google Scholar 

  15. Higa KD, Boone KB, Ho T (2000) Complications of the laparoscopic Roux-en-Y gastric bypass: 1040 patients—what have we learned? Obes Surg 10(6):509–513

    Article  CAS  PubMed  Google Scholar 

  16. Bamgbade OA, Adeogun BO, Abbas K (2012) Fast-track laparoscopic gastric bypass surgery: outcomes and lessons from a bariatric surgery service in the United Kingdom. Obes Surg 22(3):398–402

    Article  PubMed  Google Scholar 

  17. Bendewald FP et al (2011) Comparison of hand-sewn, linear-stapled, and circular-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass. Obes Surg 21(11):1671–1675

    Article  PubMed  Google Scholar 

  18. Giordano S, Tolonen P, Victorzon M (2010) Comparision of linear versus circular stapling techniques in laparoscopic gastric bypass surgery—a pilot study. Scand J Surg 99(3):127–131

    CAS  PubMed  Google Scholar 

  19. Leyba JL et al (2008) Laparoscopic gastric bypass for morbid obesity-a randomized controlled trial comparing two gastrojejunal anastomosis techniques. JSLS 12(4):385–388

    PubMed  PubMed Central  Google Scholar 

  20. Shope TR et al (2003) Early results after laparoscopic gastric bypass: EEA vs GIA stapled gastrojejunal anastomosis. Obes Surg 13(3):355–359

    Article  PubMed  Google Scholar 

  21. Cottam DR et al (2009) The effect of stoma size on weight loss after laparoscopic gastric bypass surgery: results of a blinded randomized controlled trial. Obes Surg 19(1):13–17

    Article  PubMed  Google Scholar 

  22. Sekhar N et al (2006) Endoscopic evaluation of the gastrojejunostomy in laparoscopic gastric bypass. A series of 340 patients without postoperative leak. Surg Endosc 20(2):199–201

    Article  CAS  PubMed  Google Scholar 

  23. Kravetz AJ et al (2011) A comparative study of handsewn versus stapled gastrojejunal anastomosis in laparoscopic Roux-en-Y gastric bypass. Surg Endosc 25(4):1287–1292

    Article  PubMed  Google Scholar 

  24. Awad S et al (2014) Outcomes of linear-stapled versus hand-sewn gastrojejunal anastomosis in laparoscopic Roux en-Y gastric bypass. Surg Endosc 29(8):2278–2283

    Article  PubMed  Google Scholar 

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Funding

No external funding was received for this article.

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Authors and Affiliations

  1. The East-Midlands Bariatric & Metabolic Institute (EMBMI), Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK

    Waleed Al-Khyatt, Charles A. Bull, Sherif Awad & Javed Ahmed

Authors
  1. Waleed Al-Khyatt
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  2. Charles A. Bull
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  3. Sherif Awad
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  4. Javed Ahmed
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Corresponding author

Correspondence to Sherif Awad.

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Conflict of interest

SA was recipient of a clinical Bariatric Fellowship that was supported by an unrestricted educational grant from Ethicon EndoSurgery (paid to the host centre). JA has received travel bursaries from Allergan and Speaker’s Honoraria from Ethicon EndoSurgery. CAB and WA have no conflicts of interest to declare.

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Al-Khyatt, W., Bull, C.A., Awad, S. et al. Laparoscopic Roux en-Y Gastric Bypass Using a Modified Retrocolic–Supracolic Approach: Outcomes from 300 Patients. World J Surg 40, 1918–1924 (2016). https://doi.org/10.1007/s00268-016-3478-1

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  • DOI: https://doi.org/10.1007/s00268-016-3478-1

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