Claire McElhatton, Dr1, Elizabeth Vujcich, Dr1, Jeannine McManus, Dr1, Paul Mousa, Dr2, Matthew J Lyon, Dr1, Kamal Heer, MD3, Harish Kumar, MD1. 1University of Queensland, 2Prince Charles hospital, 3Monash Univeristy
Introduction: Since the advent of the Laparoscopic approach mortality and morbidity have decreased in bariatric surgery. There are conflicting studies for and against the shorter stay. Most of the studies are a compilation of data from various sources.
The present study prospectively worked with intention to treat. All consecutives patients scheduled to have primary laparoscopic Roux-En Y gastric bypass(LGBP) or sleeve gastrectomy(LSG) under care of single bariatric surgeon were recruited. All were expected to be discharged after an overnight stay. This was with the background of preceding length of stay of 1.8 days [1-3] over four years.
Method: This abstract is based on preliminary analyzed data of 136 patients. There was no selection bias and all patients destined to have primary procedure were recruited sequentially.
The service intensified the preoperative counseling. Though there was already an established nursing culture to mobilize these patients within hours of the operation and educate patients that early mobilization was beneficial. This education and reassurance extended to their immediate family member[s] or friend[s]
The existing standard technique to do bypass was used. Side to side gastro-jejunostomy using appropriate endoscopic stapling device was standard.
LSG was fashioned with reinforced staple lining.
Intaroperatively integrity was checked with Methylene-Blue and air-leak tests. Postoperatively all patients had gastrografin swallow/meal to check integrity before they were allowed to have fluids. All patients had access to a telephone number manned by a nurse who would be available 24/7 for advice.
Results:
The interim results reflect outcomes on initial 136 patients [61% females, 39% males; 32 LSG and 104 LGBP]. Age ranged from 23 years to 71 years. Co-morbidities included usual maladies seen in this group of patients.
Average Weight/BMI: 166 kg and 58.8 kg/m2.
Operative time: 30-75 minutes for LSG and 45-190 minutes for LGBP.
| 131/136 [96.3%] | Overnight stay |
| 5/136 [3.7%] | Stayed an extra night |
| 3/5 | Admin mishap/contrast study delay |
| 1/5 | Spouse failed to collect patient |
| 1/5 | Exacerbation of asthma |
| 2/136 | Required dilatation 3-5 months post OT |
There was no leak, 30 day mortality or readmission. At 12 months average EWL was 62.4%, higher in LGBP group than LSG.
Conclusion: The strategy to reduce stay appears to be safe and has no impact on complications and expected goals.