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

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.