Skip to main content
SpringerLink
Log in

Simplified Fast-Track Laparoscopic Roux-en-Y Gastric Bypass

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

The surgical management of complex or morbid obesity is increasing exponentially. Laparoscopic procedures are being increasingly utilized due to their similar efficacy but shorter hospital stay and faster convalescence when compared with open surgery. Despite this, many patients remain in hospital for a number of days after laparoscopic obesity surgery due to concerns about potential sequelae. We present the results of our simplified fast-track service, designed to enable discharge of all patients on postoperative day one following laparoscopic Roux-en-Y gastric bypass (LRYGB).

Methods

All patients operated on by a single surgeon during a 3-year period underwent fast-track management and were included. Our simplified fast-track service has three components; it is applicable to all patients, patients are counselled regarding fast-track discharge and the only routine postoperative investigations are full blood count and serum C-reactive protein (CRP). CRP was investigated as a prognosticator for complications following LRYGB.

Results

One hundred twelve patients underwent a LRYGB during the study period (35 male, median age 44 [18–73], median BMI 49.4 [36.5–75.0]). Ninety-eight patients (87.5 %) were discharged the day after LRYGB. Five patients developed postoperative complications (three major, two minor). One patient required readmission following discharge on postoperative day 1. A CRP greater than 100 mg/L on postoperative day 1 was found to predict major complications with 100 % sensitivity and 95 % specificity with a diagnostic accuracy of 0.98.

Conclusion

Our simplified fast-track LRYGB service allows the vast majority of patients to be safely and successfully discharged on postoperative day 1.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Burns EM, Naseem H, Bottle A, et al. Introduction of laparoscopic bariatric surgery in England: observational population cohort study. BMJ. 2010;341:c4296.

    Article  PubMed  Google Scholar 

  2. Colquitt JL, Clegg AJ, Loveman E, et al. Surgery for morbid obesity. Chichester: Wiley; 2010.

    Google Scholar 

  3. Bamgbade OA, Adeogun BO, Abbas K. Fast-track laparoscopic gastric bypass surgery: outcomes and lessons from a bariatric surgery service in the United Kingdom. Obes Surg. 2012;22:398–402.

    Article  PubMed  Google Scholar 

  4. Fazylov R, Soto E, Merola S. Laparoscopic Roux-en-Y gastric bypass in morbidly obese patients > or = 55 years old. Obes Surg. 2008;18:656–9.

    Article  PubMed  Google Scholar 

  5. Collins J, Mattar S, Qureshi F, et al. Initial outcomes of laparoscopic Roux-en-Y gastric bypass in morbidly obese adolescents. Surg Obes Relat Dis. 2007;3:147–52.

    Article  PubMed  Google Scholar 

  6. Papasavas PK, Hayetian FD, Caushaj PF, et al. Outcome analysis of laparoscopic Roux-en-Y gastric bypass for morbid obesity. The first 116 cases. Surg Endosc. 2002;16:1653–7.

    Article  CAS  PubMed  Google Scholar 

  7. Nguyen NT, Ho HS, Palmer LS, et al. A comparison study of laparoscopic versus open gastric bypass for morbid obesity. J Am Chem Soc. 2000;191:149–55.

    CAS  Google Scholar 

  8. Nguyen NT, Goldman C, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;234:279–91.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Nguyen NT, Lee SL, Goldman C, et al. Comparison of pulmonary function and postoperative pain after laparoscopic versus open gastric bypass: a randomized trial. J Am Chem Soc. 2001;192:469–76.

    CAS  Google Scholar 

  10. Luján JA, Frutos MD, Hernández Q, et al. Laparoscopic versus open gastric bypass in the treatment of morbid obesity: a randomized prospective study. Ann Surg. 2004;239:433–7.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Serafini F, Anderson W, Ghassemi P, et al. The utility of contrast studies and drains in the management of patients after Roux-en-Y gastric bypass. Obes Surg. 2002;12:34–8.

    Article  PubMed  Google Scholar 

  12. Shah S, Shah V, Ahmed AR, et al. Imaging in bariatric surgery: service set-up, post-operative anatomy and complications. Br J Radiol. 2011;84:101–11.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Sims TL, Mullican MA, Hamilton EC, et al. Routine upper gastrointestinal Gastrografin swallow after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13:66–72.

    Article  PubMed  Google Scholar 

  14. Singh R, Fisher BL. Sensitivity and specificity of postoperative upper GI series following gastric bypass. Obes Surg. 2003;13:73–5.

    Article  PubMed  Google Scholar 

  15. Doraiswamy A, Rasmussen JJ, Pierce J, et al. The utility of routine postoperative upper GI series following laparoscopic gastric bypass. Surg Endosc. 2007;21:2159–62.

    Article  PubMed  Google Scholar 

  16. Carter JT, Tafreshian S, Campos GM, et al. Routine upper GI series after gastric bypass does not reliably identify anastomotic leaks or predict stricture formation. Surg Endosc. 2007;21:2172–7.

    Article  CAS  PubMed  Google Scholar 

  17. Hamilton EC, Sims TL, Hamilton TT, et al. Clinical predictors of leak after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc. 2003;17:679–84.

    Article  CAS  PubMed  Google Scholar 

  18. Lyass S, Khalili TM, Cunneen S, et al. Radiological studies after laparoscopic Roux-en-Y gastric bypass: routine or selective? Am Surg. 2004;70:918–21.

    PubMed  Google Scholar 

  19. McCarty TM, Arnold DT, Lamont JP, et al. Optimizing outcomes in bariatric surgery: outpatient laparoscopic gastric bypass. Ann Surg. 2005;242:494–501.

    PubMed Central  PubMed  Google Scholar 

  20. Elliott JA, Patel VM, Kirresh A, et al. Fast-track laparoscopic bariatric surgery: a systematic review. Updat Surg. 2013;65:85–94.

    Article  Google Scholar 

  21. Zevin B, Aggarwal R, Grantcharov TP. Simulation-based training and learning curves in laparoscopic Roux-en-Y gastric bypass. Br J Surg. 2012;99:887–95.

    Article  CAS  PubMed  Google Scholar 

  22. National Institute of Health and Care Excellence. Obesity: guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. [CG43]. London: National Institute for Health and Care Excellence; 2006.

    Google Scholar 

  23. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Ballesta C, Berindoague R, Cabrera M, et al. Management of anastomotic leaks after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18:623–30.

    Article  PubMed  Google Scholar 

  25. Fobi MAL, Lee H, Holness R, et al. Gastric bypass operation for obesity. World J Surg. 1998;22:925–35.

    Article  CAS  PubMed  Google Scholar 

  26. Madan AK, Speck KE, Ternovits CA, et al. Outcome of a clinical pathway for discharge within 48 hours after laparoscopic gastric bypass. Am J Surg. 2006;192:399–402.

    Article  PubMed  Google Scholar 

  27. Spanjersberg WR, Reurings J, Keus F, et al. Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev. 2011;2:CD007635.

    PubMed  Google Scholar 

  28. Wind J, Polle SW, Fung Kon Jin PHP, et al. Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg. 2006;93:800–9.

    Article  CAS  PubMed  Google Scholar 

  29. Varadhan KK, Neal KR, Dejong CHC, et al. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr. 2010;29:434–40.

    Article  PubMed  Google Scholar 

  30. Adamina, Kehlet, Tomlinson, et al. Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery. 2011;149:830–40.

    Article  PubMed  Google Scholar 

  31. Warschkow R, Tarantino I, Folie P, et al. C-reactive protein 2 days after laparoscopic gastric bypass surgery reliably indicates leaks and moderately predicts morbidity. J Gastrointest Surg. 2012;16:1128–35.

    Article  PubMed  Google Scholar 

  32. Csendes A. Clinical predictors of leak after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc. 2004;18:559.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like the acknowledge the invaluable help and assistance that has been provided by Ann Horsfall, Lyndsay Keeley, Maureen Sugden, Carol Thornton, Maria Fowler, Wendy Bartle, Anna Tchaikosky and Suzanne Wynne-Jones at Spire Leeds Hospital during the development of the surgery programme and care protocols. The senior author would particularly like to thank Mikael Stokel, Goran Lundergaardh and Claus Riber for providing bariatric surgical training at Hamlet Hospital in Copenhagen, Denmark.

Conflicts of Interest

All authors declare no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of HPB and Transplant Surgery, St James’s University Hospital, Leeds, LS9 7TF, UK

    Thomas W. Pike, Alan D. White & J. Peter A. Lodge

  2. Department of Bariatric Surgery, Spire Leeds Hospital, Leeds, UK

    Niki J. Snook, Stephen G. Dean & J. Peter A. Lodge

  3. Department of Anaesthesia, St James’s University Hospital, Leeds, UK

    Niki J. Snook & Stephen G. Dean

Authors
  1. Thomas W. Pike
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alan D. White
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Niki J. Snook
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stephen G. Dean
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Peter A. Lodge
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thomas W. Pike.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pike, T.W., White, A.D., Snook, N.J. et al. Simplified Fast-Track Laparoscopic Roux-en-Y Gastric Bypass. OBES SURG 25, 413–417 (2015). https://doi.org/10.1007/s11695-014-1408-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-014-1408-6

Keywords

Search

Navigation