Simplified gastric bypass: 13 years of experience and 12,000 patients operated

Almino Cardoso Ramos, Andrey Carlo Sousa Silva, Manoela Galvão Ramos, Edwin Gonzalo Claros Canseco, Manoel dos Passos Galvão-Neto, Mariano de Almeida Menezes, Thales Delmondes Galvão, Eduardo Lemos de Souza Bastos, Almino Cardoso Ramos, Andrey Carlo Sousa Silva, Manoela Galvão Ramos, Edwin Gonzalo Claros Canseco, Manoel dos Passos Galvão-Neto, Mariano de Almeida Menezes, Thales Delmondes Galvão, Eduardo Lemos de Souza Bastos

Abstract

Background: Obesity is increasingly prevalent disease worldwide and bariatric surgery is the most effective treatment for the most severe cases. The Roux-en-Y gastric bypass is still the most used technique all over the world and the laparoscopic approach has been preferred by surgeons with different approaches, propositions and techniques in performing the procedure.

Aim: To report the surgical aspects of the systematization and results of the simplified laparoscopic gastric bypass (Brazilian technique).

Methods: Were included all patients undergoing this procedure from January 2001 to July 2014; were described and analyzed aspects of this technique, the systematization and complications associated with the procedure.

Results: A total of 12,000 patients (72% women) were included, with a mean age of 43 years (14-76) and a mean BMI of 44.5 (35-90 kg/m2). Mean total operative time was 72 minutes (36-270) and the mean hospital stay was 36 hours. There were 303 cases of gastrojejunostomy stenosis (2.5%), 370 patients had gastrointestinal bleeding (3%) with only one lap revision due to a enteroanastomosis bleeding and six revisions related to intestinal obstruction caused by impacted clots in the jejunojenunostomy. Blood transfusion was needed in 32 patients (0.3%); Petersen hernia was diagnosed in 18 (0.15%) and digestive fistula in 54 (0.45%), which led to reoperation in 43 of them (67%). The overall mortality was 0.1% (fistula with sepsis=8, pulmonary thromboembolism=3; intestinal obstruction associated with sepsis=1).

Conclusion: The simplified laparoscopic gastric bypass is a feasible and safe option with low complication rate and easy reproducibility for education and training in bariatric surgery.

Conflict of interest statement

Conflicts of interest: none

Figures

Figure 1
Figure 1
Positioning of the five trocars to perform the simplified RYGB
Figure 2
Figure 2
A) Horizontal stapling - starting point in doing the gastric pouch; B) last vertical gastric stapling in making the pouch showing the technical detail with perfect visualization of the tip of the stapler near the esogastric angle and keeping safe distance to the esophagus
Figure 3
Figure 3
Transfixing suture for continuous reinforcement of the staple line in the excluded stomach with absorbable sutures
Figure 4
Figure 4
Stapler positioned to perform the gastroenterostomy calibrated with 15 mm probe
Figure 5
Figure 5
Continuous suture with nonabsorbable sutures to close the Petersen space
Figure 6
Figure 6
A) Definition of the length of the alimentary loop for enteroenterostomy with the biliopancreatic loop (AA=alimentary loop, AC=common loop; BP= biliopancreatic loop); B) section of the biliopancreatic loop near the gastroenterostomy for conversion technique in Roux-en-Y

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Source: PubMed

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