Outcomes of Laparoscopic Gastric Bypass

In the morbidly obese, surgery is the most effective option to achieve weight loss with resolution of comorbidity. Since its first description in 1967, the gastric bypass (RYGB) has continued to gain popularity. The introduction of the laparoscopic approach by Wittgrove in 1994 further increased patient acceptance, and it is now the most common bariatric procedure performed worldwide. The advantages of the laparoscopic approach include reduced mean operative time, operative blood loss, length of intensive care stay, postoperative pain, and in-hospital stay, with a faster recovery compared with the open technique with similar perioperative morbidity and mortality rates. The laparoscopic RYGB (LRYGB) procedure achieves weight loss by a combination of moderate restriction by reduction in gastric volume to 15 to 30 ml with a narrow outlet, the dumping syndrome in response to ingestion of food with a high sugar or fat content, and micronutrient malabsorption.

Short-term outcome after LRYGB is determined by surgical technique, surgeon volume, hospital volume, and surgical reintervention rate. Early outcome measures include perioperative rates of morbidity and mortality, surgical reintervention rate, and readmission rate. Early complications are classified as those occurring in the first 30 days after surgery, and late complications as those observed after 30 days. Major complications are lifethreatening complications and/or those that lead to early reoperation. Longterm outcome is determined by the avoidance of nutritional deficiencies, early detection and treatment of complications, and close follow-up in a multidisciplinary care program.