Piotr Gorecki, MD, James Nguyen, MD, Kabata Krystyna, PA, Michael E Zenilman, MD. New York Presbyterian Brooklyn Methodist Hospital
INTRODUCTION: Laparoscopic bariatric surgery is well accepted for the treatment of morbid obesity. The purpose of this study was to evaluate its feasibility and provide an update on improved safety of bariatric procedures performed in a teaching institution with minimal morbidity and mortality.
METHODS AND PROCEDURES: Perioperative data from a detailed, prospectively collected database was analyzed for each bariatric procedure as well as for all procedures collectively. All patients were evaluated in a multidisciplinary setting using the same clinical pathways. All patients met the NIH criteria for bariatric surgery. All operations were performed by a single surgeon (PG) with the assistance of surgical residents. In this study we used perioperative mortality and reoperations as the ultimate outcomes studied, since they represent the most important and visible quality and safety measures.
RESULTS: Between August 2001 and August 2017, 2315 consecutive laparoscopic bariatric operations were performed, including 706 primary Roux-en-Y gastric bypasses (LRYGB), 429 primary adjustable gastric bands (LAGB), 901 primary sleeve gastrectomies (LSG) and 279 secondary bariatric surgeries and revisions. All bariatric procedures were approached laparoscopically (1814 procedures were stapled and 501 were nonstapled). The mean patient age was 38 years (16 -73), females represented 85% and mean BMI was 48.2 kg/m2 (35-73). There were no perioperative mortalities, no conversions to open surgery and no intraoperative blood transfusions. There we two major intraoperative complications (hypopharyngeal perforation-1, malignant hyperthermia-1). Mean hospital stay was 1.45 days (1-40 days). Eleven patients (0.47%, 10 in gastric bypass group and one in LSG group) required 30-day reoperations for postoperative complications (staple line gastrointestinal bleeding -5, anastomotic leak -1, strangulated port site hernia-1, unexplained severe abdominal pain-1, intestinal obstruction -2, and intraabdominal abscess -1).There were no long term (1-year) mortalities in patients that required reoperation. There was one transfer to another institution. The dynamics of further improving safety was such that there was no complication on the recent consecutive 127 stapled procedures and the mean hospital stay was 1.1 days (1-4 days). Detailed subgroup analyses will be provided.
CONCLUSIONS: With well-controlled and structured pre-, intra-, and post-operative care, laparoscopic bariatric surgery can be performed with minimal reoperations and zero mortality in a teaching institution. Such favorable outcomes further optimize the benefits of bariatric surgery and may encourage more potential patients and referring primary physicians to pursue bariatric surgery as a preferred and optimal therapeutic management of morbidly obese patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86829
Program Number: P734
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster