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Laparoscopic Roux-en-Y gastric bypass: initial 2-year experience.

机译：腹腔镜Roux-en-Y胃搭桥术：最初2年经验。

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BACKGROUND: Roux-en-Y gastric bypass (RYGBP)-essentially a restrictive bariatric procedure-is currently considered the gold standard for the surgical treatment of morbid obesity. Open surgery in obese patients is associated with a high risk of cardiopulmonary complications, wound infection, and late incisional hernia. Laparoscopic surgery has been shown to reduce perioperative morbidity and to improve postoperative recovery for various procedures. Herein we present our results with laparoscopic RYGBP after an initial 2-year experience. METHODS: A prospective database was created in our department beginning without the first laparoscopic bariatric procedure. To provide a complete follow-up of 6 months, the results of all patients operated on between June 1999 and August 2001 were reviewed. Early surgical results, weight loss, correction of comorbidities, and improvement of quality of life were evaluated. RESULTS: A total of 107 patients were included. There were 82 women and 25 men, with a mean age of 39.7 years (range, 19-58). RYGBP was a primary procedure in 80 cases (49 morbidly obese and 31 superobese patients) and a reoperation after failure or complication of another bariatric operation in 27 cases. Mean duration of surgery was 168 min for morbidly obese patients, 196 min for surperobese patients, and 205 min for reoperated patients (p <0.01). Conversion to open surgery was necessary in two cases. A total of 22 patients (20.5%) developed complication. Nine of them (8.4%) required reoperation for leak (five cases, or 4.6%), bowel occlusion (three cases, or 2.8%), or subphrenic abscess (one case, or 0.9%). mortality was 0.9%. Major morbidity decreased over time (first two-thirds, 12.5%, last third, 2.7%). major morbidity decreased over time (first two-thirds, 12.5%; last third, 2.7%). Excess weight loss of -50% was achieved in >80% of the patients, corresponding to a loss of 15 body mass index (BMI) units in morbidly obese patients and 20 BMI units in superobese patients. In the vast majority of patients, comorbidities improved or disappeared over time and quality of life improved. CONCLUSIONS: Laparoscopic Roux-en-Y gastric bypass is feasible, but it is a very complex operation. Indeed, it is associated with a long and steep learning curve, as reflected in the high number of major complications among our first 70 patients. The learning curve probably includes between 100 and 150 patients. With increasing experience, the morbidity rate becomes more acceptable and comparable to that of open RYGBP. The results in terms of weight loss and correction of comorbidities are similar to those obtained after open surgery, at least in the short term. However, only surgeons with extensive experience in advanced laparoscopic as well as bariatric surgery should attempt this procedure.
机译：背景：目前，Roux-en-Y胃旁路术（RYGBP）-一种限制性的减肥手术-目前被认为是病态肥胖症外科治疗的金标准。肥胖患者的开放手术会增加心肺并发症，伤口感染和晚期切口疝的风险。腹腔镜手术已被证明可以减少围手术期的发病率并提高各种手术的术后恢复率。在这里，我们介绍了经过最初2年经验的腹腔镜RYGBP的结果。方法：我们的科室是在没有首次腹腔镜减肥手术的情况下创建的前瞻性数据库。为了提供6个月的完整随访，我们回顾了1999年6月至2001年8月期间所有手术患者的结果。评估了早期手术结果，体重减轻，合并症的纠正以及生活质量的改善。结果：共纳入107例患者。有82名女性和25名男性，平均年龄为39.7岁（范围19-58）。 RYGBP是80例（49例病态肥胖和31例超肥胖患者）的主要手术方法，在27例失败或合并其他减肥手术后再次手术。病态肥胖患者的平均手术时间为168分钟，超肥胖患者为196分钟，再次手术患者为205分钟（p <0.01）。有两种情况需要改用开放手术。共有22例患者（20.5％）发生了并发症。其中9例（8.4％）因渗漏（5例，占4.6％），肠梗阻（3例，占2.8％）或sub脓肿（1例，或0.9％）而需要再次手术。死亡率为0.9％。重大发病率随时间下降（前三分之二，12.5％，后三分，2.7％）。重大发病率随时间下降（前三分之二，12.5％;后三分，2.7％）。在> 80％的患者中实现了-50％的体重减轻，相当于在病态肥胖患者中减少了15体重指数（BMI）单位，在超肥胖患者中减少了20个BMI单位。在绝大多数患者中，合并症随时间推移而改善或消失，生活质量得到改善。结论：腹腔镜Roux-en-Y胃旁路术是可行的，但它是一个非常复杂的手术。确实，这与学习曲线漫长而陡峭有关，这反映在我们前70名患者中大量重大并发症中。学习曲线可能包括100到150位患者。随着经验的增加，发病率变得可以接受，并且可以与开放RYGBP相比。减肥和合并症的校正结果至少在短期内与开放手术后的结果相似。但是，只有在高级腹腔镜检查和减肥手术方面具有丰富经验的外科医生才能尝试此过程。

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