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Obesity Surgery

, Volume 19, Issue 3, pp 281–286 | Cite as

Hospital Discharge in the Day Following Open Roux-en-Y Gastric Bypass: Is it Feasible and Safe?

  • Iran dos Santos MoraesJr.
  • Carlos Augusto Scussel Madalosso
  • Luis Amauri Palma
  • Adriana Cristina da Silva Fornari
  • Maria do Socorro Dourado
  • Tiago Scherer
  • Richard Ricachenevsky Gurski
  • Fernando Fornari
Research Article

Abstract

Background

Roux-en-Y gastric bypass (RYGBP) either laparoscopic or open has been increasingly employed in the treatment of patients with morbid obesity. Laparoscopic approach is believed to be superior over open approach in terms of shorter hospital stay and easier recovery. We aimed to assess feasibility and safety of open RYGBP with short stay in comparison with laparoscopic RYGBP.

Methods

One hundred and ninety consecutive patients were assigned to open (n = 103) or laparoscopic (n = 87) RYGBP. The first 20 patients of the laparoscopic arm were excluded due to procedure learning curve. Patients were treated by a multidisciplinary team focused on successfully RYGBP with short stay (1 day).

Results

Short stay was reached by 90% of patients operated with open approach and 81% by laparoscopy (P = 0.070). Discharge in the second day was reached by 97% of patients in both groups. Procedure length [(median (IQR)] was faster for open RYGBP [103 (70–180 min) vs. 169 (105–248 min); P < 0.0001]. Thirty-day readmission rate was similar between groups (3% vs. 7%; P = 0.266). There was no death in either group.

Conclusion

Short stay (1 day) following open gastric bypass was a feasible and safe procedure. This approach might have economic impact and might increase patient acceptance for open RYGBP.

Keywords

Morbid obesity Gastric bypass Laparoscopy Length of stay Laparotomy 

Notes

Conflict of Interest

None.

References

  1. 1.
    Bray GA, Bellanger T. Epidemiology, trends, and morbidities of obesity and the metabolic syndrome. Endocrine 2006;29:109–17.CrossRefGoogle Scholar
  2. 2.
    Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 2006;295:1549–55.CrossRefGoogle Scholar
  3. 3.
    Santos LM, Oliveira IV, Peters LR, et al. Trends in morbid obesity and in bariatric surgeries covered by the Brazilian Public Health System. Obes Surg. 2008, in press.Google Scholar
  4. 4.
    Dietz WH. Childhood weight affects adult morbidity and mortality. J Nutr. 1998;128:411S–4S.CrossRefGoogle Scholar
  5. 5.
    Poves PI, Macias GJ, Cabrera FM, et al. Quality of life in morbid obesity. Rev Esp Enferm Dig. 2005;97:187–95.Google Scholar
  6. 6.
    Wee CC, Davis RB, Hamel MB. Comparing the SF-12 and SF-36 health status questionnaires in patients with and without obesity. Health Qual Life Outcomes. 2008;6:11.CrossRefGoogle Scholar
  7. 7.
    Ali MR, Fuller WD, Choi MP, et al. Bariatric surgical outcomes. Surg Clin North Am. 2005;85:835–52, vii.CrossRefGoogle Scholar
  8. 8.
    Must A, Spadano J, Coakley EH, et al. The disease burden associated with overweight and obesity. JAMA 1999;282:1523–9.CrossRefGoogle Scholar
  9. 9.
    Craig BM, Tseng DS. Cost-effectiveness of gastric bypass for severe obesity. Am J Med. 2002;113:491–8.CrossRefGoogle Scholar
  10. 10.
    Elder KA, Wolfe BM. Bariatric surgery: a review of procedures and outcomes. Gastroenterology 2007;132:2253–71.CrossRefGoogle Scholar
  11. 11.
    Buchwald H, Williams SE. Bariatric surgery worldwide 2003. Obes Surg. 2004;14:1157–64.CrossRefGoogle Scholar
  12. 12.
    Pope GD, Finlayson SR, Kemp JA, et al. Life expectancy benefits of gastric bypass surgery. Surg Innov. 2006;13:265–73.CrossRefGoogle Scholar
  13. 13.
    Poves I, Cabrera M, Maristany C, et al. Gastrointestinal quality of life after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2006;16:19–23.CrossRefGoogle Scholar
  14. 14.
    Batsis JA, Romero-Corral A, Collazo-Clavell ML, et al. Effect of bariatric surgery on the metabolic syndrome: a population-based, long-term controlled study. Mayo Clin Proc. 2008;83:897–907.CrossRefGoogle Scholar
  15. 15.
    Cummings S, Apovian CM, Khaodhiar L. Obesity surgery: evidence for diabetes prevention/management. J Am Diet Assoc. 2008;108:S40–4.CrossRefGoogle Scholar
  16. 16.
    Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238:467–84.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Cottam DR, Nguyen NT, Eid GM, et al. The impact of laparoscopy on bariatric surgery. Surg Endosc. 2005;19:621–7.CrossRefGoogle Scholar
  18. 18.
    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;234:279–89.CrossRefGoogle Scholar
  19. 19.
    Sekhar N, Torquati A, Youssef Y, et al. A comparison of 399 open and 568 laparoscopic gastric bypasses performed during a 4-year period. Surg Endosc. 2007;21:665–8.CrossRefGoogle Scholar
  20. 20.
    Jones KB Jr, Afram JD, Benotti PN, et al. Open versus laparoscopic Roux-en-Y gastric bypass: a comparative study of over 25,000 open cases and the major laparoscopic bariatric reported series. Obes Surg. 2006;16:721–7.CrossRefGoogle Scholar
  21. 21.
    Ballantyne GH, Svahn J, Capella RF, et al. Predictors of prolonged hospital stay following open and laparoscopic gastric bypass for morbid obesity: body mass index, length of surgery, sleep apnea, asthma, and the metabolic syndrome. Obes Surg. 2004;14:1042–50.CrossRefGoogle Scholar
  22. 22.
    Lujan JA, Frutos MD, Hernandez Q, et al. Laparoscopic versus open gastric bypass in the treatment of morbid obesity: a randomized prospective study. Ann Surg. 2004;239:433–7.CrossRefGoogle Scholar
  23. 23.
    Stellato TA, Hallowell PT, Crouse C, et al. Two-day length of stay following open Roux-En-Y gastric bypass: is it feasible, safe and reasonable? Obes Surg. 2004;14:27–34.CrossRefGoogle Scholar
  24. 24.
    McCarty TM, Arnold DT, Lamont JP, et al. Optimizing outcomes in bariatric surgery: outpatient laparoscopic gastric bypass. Ann Surg. 2005;242:494–8.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Raeder J. Bariatric procedures as day/short stay surgery: is it possible and reasonable? Curr Opin Anaesthesiol. 2007;20:508–12.CrossRefGoogle Scholar
  26. 26.
    Ballesta-Lopez C, Poves I, Cabrera M, et al. Learning curve for laparoscopic Roux-en-Y gastric bypass with totally hand-sewn anastomosis: analysis of first 600 consecutive patients. Surg Endosc. 2005;19:519–24.CrossRefGoogle Scholar
  27. 27.
    Flum DR, Dellinger EP. Impact of gastric bypass operation on survival: a population-based analysis. J Am Coll Surg. 2004;199:543–51.CrossRefGoogle Scholar
  28. 28.
    Zingmond DS, McGory ML, Ko CY. Hospitalization before and after gastric bypass surgery. JAMA 2005;294:1918–24.CrossRefGoogle Scholar
  29. 29.
    Davis MM, Slish K, Chao C, et al. National trends in bariatric surgery, 1996–2002. Arch Surg. 2006;141:71–4.CrossRefGoogle Scholar
  30. 30.
    Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA 2005;294:1909–17.CrossRefGoogle Scholar
  31. 31.
    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.CrossRefGoogle Scholar
  32. 32.
    McCarty TM. Can bariatric surgery be done as an outpatient procedure? Adv Surg. 2006;40:99–106.CrossRefGoogle Scholar
  33. 33.
    Lara MD, Baker MT, Larson CJ, et al. Travel distance, age, and sex as factors in follow-up visit compliance in the post-gastric bypass population. Surg Obes Relat Dis. 2005;1:17–21.CrossRefGoogle Scholar
  34. 34.
    Saunders JK, Ballantyne GH, Belsley S, et al. 30-day readmission rates at a high volume bariatric surgery center: laparoscopic adjustable gastric banding, laparoscopic gastric bypass, and vertical banded gastroplasty-Roux-en-Y gastric bypass. Obes Surg. 2007;17:1171–7.CrossRefGoogle Scholar
  35. 35.
    Breaux JA, Kennedy CI, Richardson WS. Advanced laparoscopic skills decrease the learning curve for laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2007;21:985–8.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Iran dos Santos MoraesJr.
    • 1
    • 2
  • Carlos Augusto Scussel Madalosso
    • 1
    • 2
    • 3
  • Luis Amauri Palma
    • 1
    • 2
    • 4
  • Adriana Cristina da Silva Fornari
    • 1
  • Maria do Socorro Dourado
    • 2
  • Tiago Scherer
    • 2
  • Richard Ricachenevsky Gurski
    • 3
  • Fernando Fornari
    • 1
    • 2
    • 4
  1. 1.GASTROBESEPasso FundoBrazil
  2. 2.Hospital São Vicente de PauloPasso FundoBrazil
  3. 3.Post-Graduate Program in Surgery, School of MedicineUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
  4. 4.School of MedicineUniversidade de Passo FundoPasso FundoBrazil

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