Advertisement

Gastric Bypass pp 117-123 | Cite as

Developing the Laparoscopic Gastric Bypass

  • Cássio Renato Montenegro de Lima
Chapter
  • 38 Downloads

Abstract

Bariatric surgery remains the only effective and enduring treatment for morbid obesity, which includes gastric bypass. The principles of gastric bypass surgery were developed by Mason and Ito in 1967 and have become the gold standard procedure in bariatric surgery. The first laparoscopic approach to Roux-en-Y gastric bypass (LRYGB) was described by Wittgrove. Nowadays, LRYGB is now utilized in approximately 90% of all gastric bypass procedures.

A laparoscopic approach has significant potential to reduce perioperative complications and recovery time. It reduces postoperative pain, allows faster recovery, diminished parameters of systemic injury, showed a dramatic reduction in the frequency of wound infection, and delayed ventral hernias.

Laparoscopic gastric bypass is a technically feasible procedure, which can be accomplished with acceptable morbidity, reasonable operating times, and excellent clinical results. It deserves a place in the operative repertoir of modern bariatric surgeons.

Gastric bypass has evolved over the 30 years following its initial description to include multiple modifications. On modern times, the laparoscopic approach is technically challenging but with experience can be mastered. Not only the surgeon but the whole team needs to be familiar with the special setting.

Varying techniques have been performed to the development of gastric bypass, but the anatomic and physiologic principles of the gastric bypass operation were identical between open and laparoscopic techniques. Evidences suggest that long-term weight loss is similar between open and laparoscopic techinques.

Keywords

Bariatric surgery Comorbid conditions Gastric bypass Gastric bypass/methods Laparoscopy Laparoscopy/methods Morbid obesity Obesity Morbid/surgery Postoperative complications Roux-en-Y Weight loss 

References

  1. 1.
    Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA. 2005;294(15):1909–17.PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Mason E, Ito C. Gastric bypass in obesity. Surg Clin North Am. 1967;47(6):1345–51.PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Puzziferri N, Blankenship J, Wolfe BM. Surgical treatment of obesity. Endocrine. 2006;29:11–9.PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Trus TL, Pope GD, Finlayson SRG. National trends in utilization and outcomes of bariatric surgery. Surg Endosc. 2005;19:616–20.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Tsai AG, Asch DA, Wadden TA. Insurance coverage for obesity treatment. J Am Diet Assoc. 2006;106:1651–5.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg. 2000;232(4):515–29.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Wittgrove AC, Clark GW. Laparoscopic gastric bypass, Roux-en-Y – 500 patients: technique and results, with 3-60 month follow-up. Obes Surg. 2000;10:233–9.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Elder KA, Wolfe BM. Bariatric surgery: a review of procedures and outcomes. J Gastroenterol. 2007;132(6):2253–71.CrossRefGoogle Scholar
  9. 9.
    Puzziferri N, Austrheim-Smith IT, Wolfe BM, Wilson SE, Nguyen NT. Three-year follow-up of a prospective randomized trial comparing laparoscopic versus open gastric bypass. Ann Surg. 2006;243:181–8.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Wittgrove AC, Clark GW, Schubert KR. Laparoscopic gastric bypass, Roux en-Y: technique and results in 75 patients with 3–30 months follow-up. Obes Surg. 1996;6:500–4.PubMedCrossRefGoogle Scholar
  11. 11.
    Iordens GI, Klaassen RA, van Lieshout EM, Cleffken BI, van der Harst E. How to train surgical residents to perform laparoscopic Roux-en-Y gastric bypass safely. World J Surg. 2012;36(9):2003–10.PubMedCrossRefGoogle Scholar
  12. 12.
    Cottam DR, Mattar S, Lord J, Schauer PR. Training and credentialing for the performance of laparoscopic bariatric surgery. Laparoscopy and SLS Report. 2003;2(1):15–21.Google Scholar
  13. 13.
    Wittgrove AC, Clark GW, Tremblay LJ. Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg. 1994;4:353–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Alvarado R, Alami RS, Hsu G, et al. The impact of preoperative weight loss in patients undergoing laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2005;15:1282–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Harnisch MC, Portenier DD, Pryor AD, et al. Preoperative weight gain does not predict failure of weight loss or co-morbidity resolution of laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Obes Relat Dis. 2008;4:445–50.PubMedCrossRefGoogle Scholar
  16. 16.
    Edholm D, Kullberg J, Haenni A, Karlsson FA, Ahlström A, Hedberg J, Ahlström H, Sundbom M. Preoperative 4-week low-calorie diet reduces liver volume and intrahepatic fat, and facilitates laparoscopic gastric bypass in morbidly obese. Obes Surg. 2011;21:345–50.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Sundbom M. Laparoscopic revolution in bariatric surgery. World J Gastroenterol. 2014;20(41):15135–43.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Stepaniak PS, Heij C, Buise MP, Mannaerts GH, Smulders JF, Nienhuijs SW. Bariatric surgery with operating room teams that stayed fixed during the day: a multicenter study analyzing the effects on patient outcomes, teamwork and safety climate, and procedure duration. Anesth Analg. 2012;115:1384–92.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Berbiglia L, Zografakis JG, Dan AG. Laparoscopic Roux-en-Y gastric bypass: surgical technique and perioperative care. Surg Clin North Am. 2016;96(4):773–94.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Rondelli F, Bugiantella W, Desio M, et al. Antecolic or retrocolic alimentary limb in laparoscopic roux-en-Y gastric bypass? A meta-analysis. Obes Surg. 2016;26(1):182–95.PubMedCrossRefGoogle Scholar
  21. 21.
    Silecchia G, Boru CE, Mouiel J, et al. Clinical evaluation of fibrin glue in the prevention of anastomosis leak and internal hernia after laparoscopic gastric bypass: preliminary results of a prospective randomized trial. Obes Surg. 2006;16:125–31.PubMedCrossRefGoogle Scholar
  22. 22.
    Miller KA, Pump A. Use of bioabsorbable staple reinforcement material in gastric bypass: a prospective randomized clinical trial. Surg Obes Relat Dis. 2007;3(4):417–21.PubMedCrossRefGoogle Scholar
  23. 23.
    Shikora SA. The use of staple-line reinforcement during laparoscopic gastric bypass. Obes Surg. 2004;14(10):1313–20.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Chousleb E, Szomstein S, Podkameni D, et al. Routine abdominal drains after laparoscopic Roux-en-Y gastric bypass: a retrospective review of 593 patients. Obes Surg. 2004;14(9):1203–7.PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Kavuturu S, Rogers AM, Haluck RS. Routine drain placement in Roux-en-Y gastric bypass: an expanded retrospective comparative study of 755 patients and review of the literature. Obes Surg. 2012;22(1):177–81.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Madan AK, Harper JL, Tichansky DS. Techniques of laparoscopic gastric bypass: on-line survey of American Society for Bariatric Surgery practicing surgeons. Surg Obes Relat Dis. 2008;4:166–73.PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Giordano S, Salminen P, Biancari F, Victorzon M. Linear stapler technique may be safer than circular in gastrojejunal anastomosis for laparoscopic Roux-en-Y gastric bypass: a meta-analysis of comparative studies. Obes Surg. 2011;21:1958–64.PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Garrard CL, Clements RH, Nanney L, et al. Adhesion formation is reduced after laparoscopic surgery. Surg Endosc. 1999;13(1):10–3.PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Delko T, Kraljevic M, Kostler T, Rothwell R, Droeser R, Potthast S, Oertli D, Zingg U. Primary non-closure of the mesenteric defects in laparoscopic Roux-en-Y gastric bypass: reoperations and intraoperative findings in 146 patients. Surg Endosc. 2016;30(6):2367–73.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Kawkabani MA, Denys A, Paroz A, Romy S, Suter M, Desmartines N, Meuli R, Schmidt S. The four different types of internal hernia occurring after laparoscopic Roux-en-Y gastric bypass performed for morbid obesity: are there any multidetector computed tomography (MDCT) features permitting their distinction? Obes Surg. 2011;21:506–16.CrossRefGoogle Scholar
  31. 31.
    Higa KD, Ho T, Boone KB. Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg. 2003;13(3):350–4.PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Phillips E, Santos D, Towfigh S. Working port site hernias: to close or not to close? Does it matter in the obese? Bariatric Times. 2011;8(6):24–30.Google Scholar
  33. 33.
    Campos JM, Godoy EP, Siqueira LT, Evangelista LFL, Vasconcelos CS, Ferraz AAB, FERRAZ EM. Laparoscopic gastric bypass with low use of stapler sutures. Arq Bras Cir Dig. 2008;21(2):73–6.CrossRefGoogle Scholar
  34. 34.
    Buchwald H, Estok R, Fahrbach K, Banel D, Sledge I. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery. 2007;142:621–32.PubMedCrossRefGoogle Scholar
  35. 35.
    Wittgrove AC, Martinez T. Laparoscopic gastric bypass in patients 60 years and older: early postoperative morbidity and resolution of comorbidities. Obes Surg. 2009;19(11):1472–6.PubMedCrossRefGoogle Scholar
  36. 36.
    Ahluwalia JS, Chang PC, Yeh LR, Lin HY, Chi SC, Huang CK. Single incision transumbilical laparoscopic Roux-en-Y gastric bypass-our technique. Obes Surg. 2014;24(9):1585.PubMedCrossRefGoogle Scholar
  37. 37.
    Huang CK, Houng JY, Chiang CJ, Chen YS, Lee PH. Single incision transumbilical laparoscopic Roux-en-Y gastric bypass: a first case report. Obes Surg. 2009;19(12):1711–5.PubMedCrossRefGoogle Scholar
  38. 38.
    Fernández JI, Ovalle C, Farias C, de la Maza J, Cabrera C. Transumbilical laparoscopic roux-en-Y gastric bypass with hand-sewn gastrojejunal anastomosis. Obes Surg. 2013;23(1):140–4.PubMedCrossRefGoogle Scholar
  39. 39.
    Rogula T, Daigle C, Dua M, Shimizu H, Davis J, Lavryk O, Aminian A, Schauer P. Laparoscopic bariatric surgery can be performed through a single incision: a comparative study. Obes Surg. 2014;24(7):1102–8.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Zepeda Mejia IA, Rogula T. Laparoscopic single-incision gastric bypass: initial experience, technique and short-term outcomes. Ann Surg Innov Res. 2015;9:7.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Nguyen NT, Goldman C, Rosenquist CJ, Arango A, Cole CJ, Lee SJ, Wolfe BM. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;234(3):279–89.PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Wolfe BM, Morton JM. Weighing in on bariatric surgery: procedure use, readmission rates, and mortality. JAMA. 2005;294:1960–3.PubMedCrossRefGoogle Scholar
  43. 43.
    Livingston EH, Ko CY. Assessing the relative contribution of individual risk factors on surgical outcome for gastric bypass surgery: a baseline probability analysis. J Surg Res. 2002;105:48–52.PubMedCrossRefGoogle Scholar
  44. 44.
    Nguyen NT, Morton JM, Wolfe BM, et al. The SAGES bariatric surgery outcome initiative. Surg Endosc. 2005;19:1429–38.PubMedCrossRefGoogle Scholar
  45. 45.
    Azagury DE, Morton JM. Bariatric surgery: overview of procedures and outcomes. Endocrinol Metab Clin N Am. 2016;45(3):647–56.CrossRefGoogle Scholar
  46. 46.
    Lyn-Sue JR, Winder JS, Kotch S, Colello J, Docimo S. Laparoscopic gastric bypass to robotic gastric bypass: time and cost commitment involved in training and transitioning an academic surgical practice. J Robot Surg. 2016;10(2):111–5.PubMedCrossRefPubMedCentralGoogle Scholar
  47. 47.
    Park CW, Lam EC, Walsh TM, Karimoto M, Ma AT, Koo M, Hammill C, Murayama K, Lorenzo CS, Bueno R. Robotic-assisted roux-en-Y gastric bypass performed in a community hospital setting: the future of bariatric surgery? Surg Endosc. 2011;25(10):3312–21.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Cássio Renato Montenegro de Lima
    • 1
  1. 1.Secretary of Health of Santa Catarina StateFlorianópolisBrazil

Personalised recommendations