Abstracts
1999 Digestive Disease Week

# 2187 LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS
Sunil Bhoyrul, Stanford Univ Sch of Medicine, Stanford, CA; M Kulkrani, M A Vierra, Stanford Univ, Stanford, CA

Surgery is currently the only effective treatment for morbid obesity and the Roux-en-Y gastric bypass is one of the most effective and widely performed bariatric operations. This procedure is difficult to perform laparoscopically, and in previous reported series the gastrojejunal anastomosis has been sewn by hand because of concerns about leakage from using a stapled technique. We developed a safe, reliable, and successful method of performing this operation laparoscopically, which reproduces all the important features of the open operation. The operation is performed using six 10-12mm trocars. The proximal stomach and proximal jejunum are divided using a laparoscopic 45mm linear cutter. A Roux limb is created using an ultrasonic scalpel and bipolar cautery to divide the small bowel mesentery. A stapled jejuno-jejunostomy is constructed using one firing of a 45mm linear cutter. The Roux limb is delivered retrocolic and retrogastric. A side-to-side gastrojejunostomy is created between the Roux limb and proximal stomach pouch using a 21 mm laparoscopic circular stapler inserted through an enlarged epigastric trocar site. Finally the open end of the Roux limb, through which the circular stapler was inserted, is closed with a linear cutter stapler. Between November 1997 and September 1998, we performed 14 laparoscopic Roux en Y gastric bypass operations on 13 women and 1 man (mean age 43 years, mean weight 144kg, mean Body Mass Index (BMI) 49kg/m2). Operating times ranged from 4 to 7 hours. Thirteen operations (93%) were completed laparoscopically. One was converted to an open gastric bypass because of difficulty mobilizing a large liver, and one patient required a second laparoscopy to correct a small bowel obstruction, which represented the only significant complication. Mean hospital stay was 4.3 days. There were no anastomotic leaks. At mean follow up of 5.9 months (range 2 to 12 months), the mean BMI of the group is 36kg/m2. All patients are pleased with the clinical result. Of those who had been employed, the return to work time ranged from 1 to 8 weeks. Thus the immediate morbidity of the operation was less because it is laparoscopic, while the functional results resembled those of open gastric bypass. These findings show that this method of laparoscopic Roux-en-Y gastric bypass is successful and safe. It is associated with a short hospital stay and an early return to normal activity. If the long-term data on weight loss prove to be similar to those of open gastric bypass, the laparoscopic operation will probably supplant open bypass as the bariatric operation of choice for most patients.

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