Abstract
Background: Intestinal leak is a potentially lethal complication of Roux en-Y gastric bypass (GBP). Identification of patients at high risk for leak may reduce complication rates of surgeons early in the procedure learning curve. Methods: A total of 3073 patients who underwent GBP were analyzed using univariate and multivariate logistic regression analyses of the following preoperative factors: hypertension (HTN), diabetes mellitus (DM), sleep apnea (SA), age, gender, weight, body mass index (BMI), and surgery type. Multivariate logistic regression analysis was performed for each procedure type. Results: There were 48 (1.5%) deaths. Independent risk factors for death included leak, weight, procedure type, and HTN. A total of 102 (3.2%) leaks were found. Independent factors for leak included age, male gender, SA, and procedure type. Conclusion: The data suggests that older, heavier male patients with multiple comorbid conditions are at increased risk for leak and mortality. Surgeons early in their learning curve should avoid these high-risk patients to reduce complications.
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JL Carson PM Scholz AY Chen ED Peterson J Gold SH Schneider (2002) ArticleTitleDiabetes mellitus increases short-term mortality and morbidity in patients undergoing coronary artery bypass graft surgery. J Am Coll Cardiol 40 418–423 Occurrence Handle10.1016/S0735-1097(02)01969-1 Occurrence Handle12142105
EJ DeMaria HJ Sugerman JM Kellum JG Meador LG Wolfe (2002) ArticleTitleResults of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg 235 640–647 Occurrence Handle11981209
GV Den Berghe P Wouters F Weekers C Verwaest . Bruyninckx M Schetz D Vlasselaers P Ferdinande P Lauwers R Bouillon (2001) ArticleTitleIntensive insulin therapy in critically ill patients. N Engl J Med 345 1359–1367 Occurrence Handle11794168
KD Higa KB Boone T Ho (2000) ArticleTitleComplications of the laparoscopic Roux-en-Y gastric bypass: 1,040 patients—what have we learned? Obes Surg 10 509–513 Occurrence Handle10.1381/096089200321593706 Occurrence Handle1:STN:280:DC%2BD3M7ks1WjtQ%3D%3D Occurrence Handle11175957
EH Livingston S Huerta D Arthur S Lee S De Shields D Heber (2002) ArticleTitleMale gender is a predictor of morbidity and age a predictor of mortality for patients undergoing gastric bypass surgery. Ann Surg 236 576–582 Occurrence Handle10.1097/00000658-200211000-00007 Occurrence Handle12409663
DL Malone T Genuit JK Tracy C Gannon LM Napolitano (2002) ArticleTitleSurgical site infection: reanalysis of risk factors. J Surg Res 103 89–95 Occurrence Handle11855922
EE Mason KE Renquist D Jiang (1992) ArticleTitlePerioperative risks and safety of surgery for severe obesity. Am J Clin Nutr 55 73S–76S
AH Mokdad BA Bowman ES Ford F Vinicor JS Marks JP Koplan (2001) ArticleTitleThe continuing epidemic of obesity and diabetes in the United States. JAMA 286 1195–1200 Occurrence Handle1:STN:280:DC%2BD3MrhvVegsw%3D%3D Occurrence Handle11559264
MM Murr MR Siadati MG Sarr (1995) ArticleTitleResults of bariatric surgery for morbid obesity in patients older than 50 years. Obes Surg 5 399–402 Occurrence Handle10.1381/096089295765557494 Occurrence Handle10733835
KJ Printen EE Mason (1977) ArticleTitleGastric bypass for morbid obesity in patients more than fifty years of age. Surg Gynecol Obstet 144 192–194 Occurrence Handle1:STN:280:CSiC3crhtlU%3D Occurrence Handle835056
CJ Ren E Patterson M Gagner (2000) ArticleTitleEarly results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients. Obes Surg 10 514–523 Occurrence Handle10.1381/096089200321593715 Occurrence Handle1:STN:280:DC%2BD3M7ks1Wjug%3D%3D Occurrence Handle11175958
P Schauer S Ikramuddin W Gourash R Ramanathan J Luketich (2000) ArticleTitleOutcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 232 515–529 Occurrence Handle10.1097/00000658-200010000-00007 Occurrence Handle1:STN:280:DC%2BD3M%2Fhs1eitA%3D%3D Occurrence Handle10998650
P Schauer S Ikramuddin G Hamad W Gourash (2003) ArticleTitleThe learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases. Surg Endosc 17 212–215 Occurrence Handle10.1007/s00464-002-8857-z Occurrence Handle1:STN:280:DC%2BD3s%2Fms12qsA%3D%3D Occurrence Handle12457218
RW Schwartz WE Strodel WS Simpson WO Griffen (1988) ArticleTitleGastric bypass revision: lessons learned from 920 cases. Surgery 104 806–812 Occurrence Handle1:STN:280:BiaD3MbotVQ%3D Occurrence Handle3051478
Sugerman HJ, DeMaria EJ, Kellum J, Wolfe L, Sugerman E, Meador J (2003) Effects of bariatric surgery in older patients. (Accepted to 2003 Meeting of ASBS)
HJ Sugerman JM Kellum EJ DeMaria (1996) ArticleTitleConversion of failed or complicated vertical banded gastroplasty to gastric bypass in morbid obesity. Am J Surg 171 263–269 Occurrence Handle10.1016/S0002-9610(97)89565-7 Occurrence Handle1:STN:280:BymC2sjhvFw%3D Occurrence Handle8619465
AC Wittgrove WC Clark (2000) ArticleTitleLaparoscopic gastric bypass, Roux en-Y—500 patients: technique and results, with 3–60 month follow-up. Obes Surg 10 233–239 Occurrence Handle1:STN:280:DC%2BD3cvotFOlsQ%3D%3D Occurrence Handle10929154
KJ Zerr AP Furnary GL Grunkemeier A Starr (1999) ArticleTitleContinuous intravenous insulin infusion reduces the incidence of deep sternal wound infections in diabetic patients after cardiac surgical procedures. Ann Thorac Surg 67 352–360 Occurrence Handle10.1016/S0003-4975(99)00014-4 Occurrence Handle10197653
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Fernandez Jr, A., DeMaria, E., Tichansky, D. et al. Experience with over 3,000 open and laparoscopic bariatric procedures: Multivariate analysis of factors related to leak and resultant mortality. Surg Endosc 18, 193–197 (2004). https://doi.org/10.1007/s00464-003-8926-y
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DOI: https://doi.org/10.1007/s00464-003-8926-y