Abstracts
2000 Digestive Disease Week

# 2332 Laparoscopic, Open and Handport-Assisted Laparoscopic Roux-En-Y Gastric Bypass - a Comparative Study.
Sven Os Gustavsson, Magnus Sundbom, Agneta Westling, Uppsala, Sweden

The efficacy of Roux-en-y Gastric bypass (RGBP) in morbid obesity is well documented. We have investigated the role of minimally invasive surgical techniques for performing RGBP. In the first part of the study, 51 patients (48 females, median age 34) with morbid obesity (BMI 42 kg/m2) were randomly allocated to either laparoscopy (n = 30) or laparotomy (n = 21) during 1997-98. In the second part 12 consecutive patients (all female, age 38, BMI 43 kg/m2) underwent HandPort assisted laparoscopic RGBP in an open series during 1999. The stomach was always completely transected. The Roux limb was made > 50 cm and brought to the proximal gastric pouch (4 x 3 cm) behind the colon and the excluded stomach. In the first part of the study the gastrojejunostomy was stapled with 30 mm linear stapler and defects hand-sewn. In the second a circular stapler (no 21) was used with the anvil introduced through a gastrotomy. The HandPort was introduced through an 8 cm right subcostal incision. In the first part of the study 7 patients (23%) had to be converted from laparoscopy to laparotomy usually due to lack of proper exposure. The duration of surgery was 235 and 100 min, respectively (analysis with converted patients excluded). The amount of morfin taken by PCA during postop day 1-3 was significantly (p< 0,005) lower among laparoscopy patients (69 mg) in comparison with patients in the open group (140 mg). Likewise, postoperative hospital stay was shorter after laparoscopy (4 days), against 6 days after laparotomy. Six laparoscopy patients had to be re-operated within one month due to obstruction of the Roux limb at the level of the mesocolon. In HandPort-assisted laparoscopy duration of surgery (including learning curve time), amount of morfin and postoperative hospital stay were 207 min, 74 mg and 5 days, respectively. One patient (8 %) was converted to laparotomy for safe closure of a small perforation of the proximal gastric pouch caused by the anvil of the circular stapler. There were no cases of early obstruction of the Roux limb. The expected benefits of laparoscopy i.e. reduced postoperative pain and short hospital stay were confirmed. However, conversions and obstruction of the Roux limb in _ of patients indicate that the technique of laparoscopic RGBP has to be further improved before it can be introduced into our clinical routine. HandPortassistance may be such an improvement.