Comparison of Laparoscopic and Open Revision Roux-en-y Gastric Bypass

Y Assadipour, MD, K Vaziri, MD, J Holzmacher, MD, Richard L Amdur, PhD, Juliet Lee, MD, Paul P Lin, MD. The George Washington University Hospital.

Revision Roux-en-Y gastric bypass (RRYGB) is performed in patients who have undergone bariatric surgery, but experienced recidivism or complications which have failed medical management. Traditionally, revisions have been approached in an open fashion given the high risk of anastomotic leak (as high as 20%) and other morbidities. The purpose of this study is to compare outcomes of patients who have undergone laparoscopic and open RRYGB.
A retrospective review of clinical data from all patients who had undergone RRYGB at a single institution was performed. The data on pre-operative co-morbidities, operative variables, and post-operative outcomes were collected and analyzed using t-test and chi square with Yates’ correction.
Ninety-six RRYGB were performed of which 17 were laparoscopic. There was no significant difference in preoperative comorbidities of gender, age, BMI, diabetes, hypertension, or sleep apnea. Average follow up was 20.3 months. Laparoscopic RRYG was performed with a significantly lower blood loss and a trend towards a shorter operative time, and higher % excess weight loss (%EWL) when compared to open RRYGB. There was no significant difference in surgical morbidity, mortality, ICU days or length of stay between laparoscopic and open RRYGB (Table 1). The anastomotic leak rate for open revisions was 2.5%. There were no leaks in the laparoscopic revision group.
Revision RYGB can be performed safely with an anastomotic leak rate that approximates de novo RYGB. A laparoscopic approach can be performed safely with significantly less blood loss and a trend towards a shorter operative time and greater excess weight loss when compared to open revisions. Long term comparable weight loss was achieved without an effect on morbidity or mortality. Future larger studies may be able to demonstrate a significantly shorter operative times and superior excess weight loss of laparoscopic RRYGB.

Table 1: Outcomes
  OPEN              (n=79)  LAPAROSCOPIC (n=17) p
OR Time (minutes) 206.0 +/- 61.67 n=69 170.8 +/- 60.23 n=10 0.095
Estimated Blood Loss 171.49 +/- 148.52 n=78 56.82 +/- 100.35 n=17 0.004
ICU Stay 0.81 +/- 1.16 n=78 0.93 +/- 1.49 n=15 0.884
Length of Stay 5.56 +/- 3.1 n=78 4.69 +/- 1.92 n=16 0.284
% EWL (12 months) 45.05 +/- 17.36 n=27 62.39 +/- 10.23 n=2 0.179
Mortality 0 0 0
Bleeding 1 0 0.641
MI 1 0 0.641
Leak 2 0 0.507
Wound Infection 3 1 .696
DVT 1 0 0.641
Pneumonia 0 0 0



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