Oct. 20, 2000 PITTSBURGH, Oct. 16 -- Laparoscopic Roux-en-Y gastric bypass surgery is a safe and effective procedure for achieving significant weight loss in morbidly obese people, with a low rate of complications, a short hospital stay and rapid recovery, according to a study in the October issue of the Annals of Surgery.
The study, by Philip Schauer, M.D., assistant professor of surgery at the University of Pittsburgh School of Medicine, co-director of the Mark Ravitch/Leon C. Hirsch Center for Minimally Invasive Surgery at UPMC Health System in Pittsburgh and director of bariatric surgery, evaluated the short-term outcomes of the procedure in 275 patients with a follow-up of one to 31 months.
"Open Roux-en-Y gastric bypass is a highly successful and accepted approach to morbid obesity but results in significant post-operative complications," Dr. Schauer said. "This study found that the laparoscopic or minimally invasive approach has significant potential to reduce these complications and recovery times."
In minimally invasive surgery, surgeons make four or five small, half-inch-long incisions, rather than one large incision, to access the abdominal cavity. A tiny video camera and small instruments are inserted through the incisions and surgeons view the operation on a television monitor.
The Roux-en-Y gastric bypass procedure involves constructing a small stomach pouch of approximately 15 millimeters (about the size of a plastic medicine cup), and bypassing a small segment of intestines by constructing a Y-shaped limb of small bowel. Patients lose weight because there is a decrease in caloric intake resulting from the reduced reservoir capacity of the small gastric pouch. This creates a sense of satiety when only a small quality of food is consumed. Furthermore, there is a decrease in absorption of some calories because some of the intestine is bypassed. Long-term weight loss is generally 70 to 75 percent of the excess weight.
Patients in the study ranged in age from 17 to 68. They averaged over 300 pounds prior to surgery. Many of the patients had numerous other medical problems including sleep apnea, diabetes, depression and cardiopulmonary disease. Some 63 percent had prior abdominal surgery.
"Although one patient died from a pulmonary embolus, the early surgical complication rate was only 3.3 percent for major complications and 27 percent for minor complications," Dr. Schauer said. "Following surgery, excess weight loss at 24 and 30 months was 83 percent and 77 percent respectively. In patients with more than one year of follow-up, most of their comorbidities were improved or resolved, and 95 percent of the patients reported significant improvement in their quality of life."
For example, 64 of the pre-operative patients had osteoarthritis/degenerative joint disease. Following surgery, 47 percent said their condition was improved and 41 percent said it was resolved. For those with hypertension (57 patients), 70 percent said it was resolved following gastric bypass surgery. Diabetics, who often required over 100 units of insulin per day, had the most profound improvement with an 83 percent cure rate. The remaining 17 percent were vastly improved.
"The laparoscopic approach appears to result in rapid recovery in terms of the indices evaluated in our study, allowing patients to return to full activity quickly," Dr. Schauer said. "This is particularly important in the morbidly obese patient, who often is limited in daily living activities before surgery and thus may have significant difficulty after surgery as well.
"The important outcomes relating to the goal of open bariatric surgery such as weight loss and improvement of comorbidities and quality of life appear to be equally favorable for minimally invasive gastric bypass. Long term follow-up, however, will be necessary to confirm that the laparoscopic approach is equally enduring."
Since there are nearly 8 million people in this country suffering from severe obesity and only surgery has any proven long-term benefit, a minimally invasive approach to gastric bypass offers many patients, who would otherwise shun surgery, a chance to reconsider surgery as a permanent solution to this devastating disease of obesity, Dr. Schauer said.
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