Maykong Leepalao, MD, Daniela Arredondo, MD, Fredne Speights, MD, Titus Duncan, MD. Surgery Center of Atlanta
Introduction: The objective of this research was to study safety and outcomes in select patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) on an ambulatory outpatient basis. As the prevalence of morbid obesity increases in the United States, more patients are opting for surgical weight loss as a means to combat their chronic disease. The two most common weight loss operations in the United States are laparoscopic sleeve gastrectomy (LS) and laparoscopic Roux-en-Y gastric bypass. The feasibility and safety of ambulatory LS has recently been established. However, there is sparse data regarding the feasibility of patients undergoing ambulatory, outpatient LRYGB. There are several studies demonstrating the safety and feasibility of select patients undergoing LRYGB on a 23-hour outpatient basis, but few studies exist regarding the safety and efficacy of these procedures being performed on an ambulatory outpatient basis.
Methods and Procedures: A retrospective review was completed on all patients who underwent a laparoscopic gastric bypass procedure from 2008 to 2018 at a single outpatient ambulatory surgery center. Median BMI was 46.7 kg/m2. All patients received preoperative antibiotics and deep venous thrombosis prophylaxis. Inclusion criteria included age greater than 18 and less than 65, American Society of Anesthesiologists (ASA) class less than 3, completion of a bariatric surgery preparation program, no history of major cardiovascular events, no prior major open abdominal operations. Exclusion criteria included males > 55 years, body mass index (BMI) > 55 for men and BMI > 60 for women. Operations included primary LRYGB procedures. We determined 30-day post-operative morbidity and mortality for all patients.
Results: There were 398 patients who underwent a LRYGB on an ambulatory basis in this series. After thorough chart review, there were a total of 362 patients included in our study. The rest were excluded for conversions or incomplete data. The median age was 42 (range 19-65). Seven (1.93%) patients had to be admitted to the hospital from the outpatient surgery center. Fourteen (3.87%) patients were admitted to the hospital within 30 days after initial discharge. There were 4 (1.11%) leaks, 4 (1.11%) bleeds requiring transfusion, no wound infections, 3 (0.83%) obstructions, one (0.28%) venous thrombotic event and/or pulmonary embolism, and 9 (2.49%) reoperations. There were zero deaths.
Conclusions: This study demonstrates that laparoscopic Roux-en-Y gastric bypass is both feasible and safe when performed on select patients on an ambulatory outpatient basis.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 92595
Program Number: S105
Presentation Session: Bariatric III – Optimizing Care and Pathways
Presentation Type: Podium