Abstracts
2000 Digestive Disease Week

# 2336 A Comparison of Hand-Assisted, Laparoscopic and Open Roux-En-Y Gastric Bypass Surgery.
Bradley J. Needleman, Charles H. Cook, Lawrence J. Damore, E. Christopher Ellison, E. Domiguez, W. S. Melvin, Columbus, OH

Introduction: Conventional bariatric surgery is associated with complications related to its large incision, including infection and hernia. We hypothesized that a hand-assisted, laparoscopic Roux-en-y gastric bypass is a good alternative to an open operation. Methods: From June 1998 to November 1999, 105 pts. were referred, on an alternating rotation, to one of three surgeons at the same institution for a Roux-en-Y gastric bypass. One surgeon performed a hand assisted, laparoscopic Roux-en-Y gastric bypass (35 pts.) and the other two surgeons performed an open Roux-en-Y gastric bypass through a midline incision (70 pts.). Statistical comparison between the two groups was made using a two sample Student’s T-test and Chi-square analysis. Results: No significant difference in age or gender was seen between the two groups (41.2 vs. 41.6 years, 86% vs. 80% female). The BMI’s of the two groups were 55.3 vs. 54.4. Mean operative time for all patients was significantly less for the open surgery, 137.5 vs. 212.4 minutes (p=0.001). However in the last 15 cases, the mean operative time in the hand-assisted operations was reduced to 147.2 minutes compared with 129.9 minutes open, (p<0.02). The incidence of wound infections in both groups was similar, with an incidence of 22.9% in the open surgery vs. 17.0% in the hand-assisted group. Hernias were seen in 10.0% of open and 8.5% in the hand-assisted group. A significant difference was seen in the number of patients who required reoperation in the early postoperative period due to wound complications, 4 patients (5.7%) in the open group and none in the hand-assisted group (2 for dehiscence, 1 for SBO and 1 for infection). There were no anastomotic leaks in any of the 105 pts. There was a slightly decreased length of stay in the laparoscopic group, 5.3 vs. 4.7 days. Followup ranged from 2 weeks to 14 months postoperatively. Conclusions: Hand-assisted, laparoscopic Roux-en-Y gastric bypass is a safe and effective alternative in bariatric surgery. After a learning curve, it may be performed with operative times comparable to open surgery. Although the overall rates of wound complications appear similar, significantly fewer patients were found to require reoperations for wound complications when a hand assisted laparoscopic approach is utilized.