Abstracts
2002 Digestive Disease Week

# 105406 Abstract ID: 105406 Laparoscopic Roux en-Y Gastric Bypass in Super- and Suprasuper-Obese Patients: Results from Our Intital Series of 137 Patients.
Richard A Perugini, Donald Czerniach, Yuri Novitsky, Demetrius Litwin, John J Kelly, Worcester, MA

Laparoscopic Roux en-Y gastric bypass (LRYGB) has been proven to be as effective as the open procedure for morbid obesity. Excessive obesity (body mass index {BMI} greater than 50-60 kg/m2) is considered a relative contraindication to the laparoscopic approach, though there is little clinical evidence to support this. We present the results of our initial series of patients of all degrees of obesity. Consecutive patients who met NIH criteria for bariatric surgery were offered laparoscopic RYGB, with no exclusion criteria related to BMI or overall weight. A gastric pouch of approximately 30 ml and a Roux limb of 120 cm were created in the majority of patients. Differences were analyzed by ANOVA (operating time, length of stay), Pearson chi-square (readmission rate, conversion rate) and Fisher Freeman-Halton test (complication rate, gastrojejunal stricture rate). Patients were divided into group I (BMI < 50, n = 59), Group II (50 = BMI < 60, n = 48) and Group III (BMI = 60, n = 30). The median follow up was 195 days (range 30 to 644). Out of 137 consecutive patients who presented to our group, only three (2%) required open RYGB. The OR time, post operative length of stay, readmission rate and rate of serious complications (i.e. requiring invasive intervention, causing persistent organ dysfunction or death) did not differ between different classes of obesity. There was a trend towards increased rate of stricture of the gastrojejunal anastamosis in Group III (BMI > 60, p = 0.15). Most patients in our series have had a successful result with regards to weight loss. Two deaths occurred (mortality 1.5%), and were related to leak from the gastrojejunal anastamosis. Laparoscopic RYGB is feasible in patients with excessive degrees of obesity, with comparable operating time, length of stay, perioperative and postoperative complication rates. There may be a trend towards a higher stricture rate at the gastrojejunal anastamosis in patients with BMI > 60.