BACKGROUND: Roux-en-Y gastric bypass is one of the most common operations for morbid obesity. Laparoscopic techniques have been reported, but refer longer operative time and seemingly higher initial complication rates as compared to the open procedure. The minimally invasive aproach continues to be a challenge even to the most experienced laparoscopic surgeons. The purpose of this paper is to describe our experience with the laparoscopic Roux-en-Y gastric bypass (LRYG), using a gastric pouch to jejunal anastomosis with a EEA stapler. METHOD: From September 1999 to May 2001, 102 patients were submitted to LRYG, using a gastric pouch jejuno anastomosis with a EEA stapler. Jejuno-jejunal anastomosis was carryed on at a distance of 100cm to 150cm according to the body mass index (BMI). A prospective analysis was undertaken to identify technical success, leak rate and postoperative incidence of anastomotic stenosis and its management, in a consecutive series of patients undergoing LRYG, with gastrojejunal anastomosis performed with a 25mm or 28mm stapler. In the last 10 cases this anastomosis was carryed on by hand suture. RESULTS: Mean age was 37,5 years (range 17-62) and mean BMI was 50,3kg/m² (range 35-78). The mean operative time was 119min. (55-210). The mean postoperative hospital stay was 4,3 days (2-10). Two super obese patients were converted to an open precedure for technical difficulties. Two patients died (1,9%) both from pulmonary embolism. There was 1 leak (0,9%) from the gastrojejunal anastomosis managed without operation. Fifteen patients (14,7%) developed anastomotic stenosis, that required endoscopic baloon dilatation. Nine of them required only a single dilatation and had no recurrence of dysphagia. Six needed 2 to 4 dilatations and all of them are swallowing normaly. In twenty patients, after 12 months of follow-up, the mean decrease in BMI was 21,1kg/m². CONCLUSIONS: LRYG with the stapled EEA gastrojejunal anastomosis is safe and effective. Stenosis ocurred and were managed by endoscopic dilatation, but with the use of EEA 28 or hand suture, they did not happen anymore. There were two deaths in super obeses patients whose operations were converted to open procedure and developed pulmonary embolism.
Morbid obesity; Gastric bypass; Laparosocopic surgery; Operative technique; Bariatric surgery
