Minimally Invasive Surgery For Morbid Obesity Has Favorable Outcomes,

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Source: University Of Pittsburgh Medical Center

Date: 2000-10-20

URL: http://www.sciencedaily.com/releases/2000/10/001017073317.htm

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Minimally Invasive Surgery For Morbid Obesity Has Favorable

Outcomes, According To University Of Pittsburgh Study

PITTSBURGH, Oct. 16 -- Laparoscopic Roux-en-Y gastric bypass surgery

is a safe and effective procedure for achieving significant weight

loss in morbidly obese people, with a low rate of complications, a

short hospital stay and rapid recovery, according to a study in the

October issue of the ls of Surgery.

The study, by Philip Schauer, M.D., assistant professor of surgery

at the University of Pittsburgh School of Medicine, co-director of

the Mark Ravitch/Leon C. Hirsch Center for Minimally Invasive

Surgery at UPMC Health System in Pittsburgh and director of

bariatric surgery, evaluated the short-term outcomes of the

procedure in 275 patients with a follow-up of one to 31 months.

" Open Roux-en-Y gastric bypass is a highly successful and accepted

approach to morbid obesity but results in significant post-operative

complications, " Dr. Schauer said. " This study found that the

laparoscopic or minimally invasive approach has significant

potential to reduce these complications and recovery times. "

In minimally invasive surgery, surgeons make four or five small,

half-inch-long incisions, rather than one large incision, to access

the abdominal cavity. A tiny video camera and small instruments are

inserted through the incisions and surgeons view the operation on a

television monitor.

The Roux-en-Y gastric bypass procedure involves constructing a small

stomach pouch of approximately 15 millimeters (about the size of a

plastic medicine cup), and bypassing a small segment of intestines

by constructing a Y-shaped limb of small bowel. Patients lose weight

because there is a decrease in caloric intake resulting from the

reduced reservoir capacity of the small gastric pouch. This creates

a sense of satiety when only a small quality of food is consumed.

Furthermore, there is a decrease in absorption of some calories

because some of the intestine is bypassed. Long-term weight loss is

generally 70 to 75 percent of the excess weight.

Patients in the study ranged in age from 17 to 68. They averaged

over 300 pounds prior to surgery. Many of the patients had numerous

other medical problems including sleep apnea, diabetes, depression

and cardiopulmonary disease. Some 63 percent had prior abdominal

surgery.

" Although one patient died from a pulmonary embolus, the early

surgical complication rate was only 3.3 percent for major

complications and 27 percent for minor complications, " Dr. Schauer

said. " Following surgery, excess weight loss at 24 and 30 months was

83 percent and 77 percent respectively. In patients with more than

one year of follow-up, most of their comorbidities were improved or

resolved, and 95 percent of the patients reported significant

improvement in their quality of life. "

For example, 64 of the pre-operative patients had

osteoarthritis/degenerative joint disease. Following surgery, 47

percent said their condition was improved and 41 percent said it was

resolved. For those with hypertension (57 patients), 70 percent said

it was resolved following gastric bypass surgery. Diabetics, who

often required over 100 units of insulin per day, had the most

profound improvement with an 83 percent cure rate. The remaining 17

percent were vastly improved.

" The laparoscopic approach appears to result in rapid recovery in

terms of the indices evaluated in our study, allowing patients to

return to full activity quickly, " Dr. Schauer said. " This is

particularly important in the morbidly obese patient, who often is

limited in daily living activities before surgery and thus may have

significant difficulty after surgery as well.

" The important outcomes relating to the goal of open bariatric

surgery such as weight loss and improvement of comorbidities and

quality of life appear to be equally favorable for minimally

invasive gastric bypass. Long term follow-up, however, will be

necessary to confirm that the laparoscopic approach is equally

enduring. "

Since there are nearly 8 million people in this country suffering

from severe obesity and only surgery has any proven long-term

benefit, a minimally invasive approach to gastric bypass offers many

patients, who would otherwise shun surgery, a chance to reconsider

surgery as a permanent solution to this devastating disease of

obesity, Dr. Schauer said.