For Gastric Bypass, Seek Experienced Surgeon

Less invasive weight loss surgery is on the rise, but patients need to look for hospitals that have performed this procedure at least 100 times to help ensure their safety.

Interest in gastric bypass surgery, in which part of the stomach is bypassed to help obese people lose weight, continues to grow. And now surgeons are increasingly turning to a less invasive technique called laparascopic gastric bypass surgery.

Instead of a large cut down the center of the abdomen, this technique uses several small cuts to perform the surgery, using a camera to see inside the abdomen. Recovery time after this technique is generally much shorter than after traditional surgery, and patients experience less pain.

Double-Edged Sword

While the researchers say introduction of this new technique has been of "tremendous overall benefit," they add that it's also a "double-edged sword."

It dramatically decreases infection rates, pain after surgery, and length of hospital stay. But it's much more technically challenging than the traditional surgery technique.

So researchers at Tufts-New England Medical Center wanted to see if safety of this new technique improved as more of these surgeries were done. They were specifically evaluating the safety of a weight loss surgery procedure called Roux-en-Y gastric bypass.

The study by Scott A. Shikora, MD, and colleagues appears in the April issue of the Archives of Surgery.

The researchers looked at 750 consecutive laparoscopic surgeries done between March 1998 and April 2004. On average, the patients had a body mass index (BMI) of 47.

A BMI over 25 is associated with increased health risks such as heart disease and diabetes. But weight loss surgery is generally reserved for patients with a BMI over 35 who have obesity-related health conditions and who have been unsuccessful with diet and exercise programs.

Fewer Problems After 100 Surgeries

Researchers found that major complications from the surgery fell significantly once at least 100 surgeries had been performed at a hospital.

Blood loss, operating time, and length of hospital stay all improved.

Average operating time fell from 212 minutes for the first 100 cases to 163 minutes for the next 100 cases. That's important for safety because less time under anesthesia lowers the chance of complications during and after surgery. By the last 100 surgeries, operating time had fallen to 105 minutes.

Complications occurred in 26 percent of the first 100 cases compared with 11% in the next 100 cases. Possible complications include infection and damage to internal organs.

There was only one death in the first 100 cases. There were no deaths in the last 100 cases.

Safer Than Ever

"The procedure has never been safer owing to the introduction of minimally invasive technologies but also to the improvements in patient preparation, anesthetic management, and postoperative care," write the researchers.

They say that looking for a hospital that has done at least 100 laparoscopic gastric bypass surgeries should help decrease complications seen with this challenging procedure.

By Michael W. Smith, MD, reviewed by Brunilda Nazario, MD

SOURCE: Shikora, S. Archives of Surgery, April 2005; vol 140: pp 362-367.