2008 Annual Meeting Abstracts
Low Morbidity and Zero Mortality in an Initial Experience of 500 Gastric Bypass Procedures
Jennifer E. Verbesey, M.D., Pam O'Brien, NP, MSN, Corinne Vigilante, NP, MSN, Mary Ann Simpson, PhD, Dmitry Nepomnayshy, MD, David Brams, MD.
Lahey Clinic, Burlington, MA, USA.
Objectives: To describe a protocol for Roux-en-Y gastric bypass (GB) which has resulted in zero mortality in our first 500 operations.
Design: Inception Cohort
Setting: Academic medical center
Participants: Three surgeons performed 500 consecutive primary Roux-en-Y GB procedures (408 females, 92 males). Initial average weight was 306.6±62.0 pounds (288.8±50.5 female, 364.4±71.0 male), BMI was 48.0±9.3. Average age was 43.5±10.5 years. Comorbidities included diabetes (83, 16.7%), hypertension (165, 33%), sleep apnea (72, 14.4%), reflux (137, 27.4%), hypercholesterolemia (88, 17.6%) and arthritis (286, 57.2%).
Interventions: Patients were carefully screened and required to lose 8-10% of their body weight (liquid protein diet if super-obese), and participate in an exercise program. Noncompliant patients were not offered surgery. Included were 80 open GB (14%) and 430 laparoscopic GB (86%), of which 27 were converted to open (5.4%). Initial cases utilized a circular stapled retrocolic technique; later a linear stapled, hand sutured antecolic technique was used. Enteric anastomoses were stapled. Patients were closely monitored postoperatively using a standardized protocol.
Main Outcome Measures: Morbidity and mortality rates
Results: There were no deaths. Complication rate was 18% (117 complications in 90 patients). Major complication rate (requiring intervention) was 5.2% (26 events). Operative repair of incisional hernia was performed in 10 additional patients (2%). Average length of stay was 3 days (range 1-68). Readmission within 30 days occurred in 53 (10.6%) patients: 14 (2.8%) within 60 days.
Conclusions: Stringent preoperative screening, preoperative weight loss and exercise, and experience-defined modifications in surgical technique have resulted in this high-risk patient population with a zero incidence of procedure related mortality and acceptable morbidity rates, making this a model for bariatric centers early in their experience.