Comparison of Laparoscopic and Open Revision Roux-en-Y Gastric Bypass.
Yasmine Assadipour, Khashayar Vaziri Jeremy L Holzmacher, Richard Amdur, P Lin
Background
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 risk of
anastomotic leak and other morbidities, which has been reported in the literature to be as high as
20%. The purpose of this study is to compare outcomes of patients who have undergone
laparoscopic and open RRYGB.
Methods
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.
Results
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. There was a significantly lower blood loss in the
laparoscopic group. The laparoscopic group had a shorter operative time, and had higher %
excess weight loss, although this was not significant. There was no significant difference in ICU
days or length of stay. Similarly, there was no significant difference in morbidity 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.
Conclusion
Revision RYGB can be performed safely with a lower incidence of anastomotic leak than
originally reported. 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 shorter operative
times and superior weight loss of laparoscopic revisional bariatric surgery.
Table 1: Outcomes
OR Time (minutes)
Estimated Blood Loss
OPEN (n=79)
206.0 +/- 61.67 n=69
171.49 +/- 148.52 n=78
LAPAROSCOPIC (n=17)
170.8 +/- 60.23 n=10
56.82 +/- 100.35 n=17
p
0.095
0.004
ICU stay
Length of Stay
% EWL (12 months)
Mortality
Bleeding
MI
Leak
Wound Infection
DVT
Pneumonia
0.81 +/- 1.16 n=78
5.56 +/- 3.1 n=78
45.05 +/- 17.36 n=27
0
1
1
2
3
1
0
0.93 +/- 1.49 n=15
4.69 +/- 1.92 n=16
62.39 +/- 10.23 n=2
0
0
0
0
1
0
0
0.884
0.284
0.179
0
0.641
0.641
0.507
.696
.641
0