2002 Papers - Telian


Postoperative Radiographic Evaluation of Open vs. Laparoscopic Bypass Procedures
Simon H. Telian, MD Paul T. Cirangle, MD
Tripler Army Medical Center

Introduction: The Roux-en-Y Gastric Bypass procedure has clearly been demonstrated to be an effective treatment for patients suffering from morbid obesity and the associated co-morbidities. Controversy exists in the surgical community whether laparoscopic bypasses are equivalent to open procedures. The two critical technical components of the gastric bypass procedure are the volume of the gastric pouch and the size of the gastro-jejunal anastomosis. For this study, a mathematical model was developed to objectively quantify these parameters and compare them postoperatively in patients undergoing laparoscopic procedures vs. open surgery.

Methods: Retrospectively, 30 consecutive patients were compared in each group (Laparoscopic Roux-en-Y vs. Open Roux-en-Y). Patients were well matched demographically. All patients underwent postoperative digitized contrast studies and mathematical determination of gastric pouch volume and anastomotic area in a blinded fashion. Results were analyzed statistically using ANOVA and the t-test.

Results: Mean pouch volume for laparoscopic procedures was 14.8 cc vs. 27.3 cc for the open bypass patients (P<.05). The mean gastro-jejunal anastomotic area of the laparoscopic group was 28.27 cm3 vs. 40.84 cm3 for the open group (p<.05).

Conclusions: We have described a simple, accurate, and objective technique of qualifying the anatomical results of a gastric bypass procedure. Laparoscopic Roux-en-Y Bypass is at least equivalent to Open Bypass anatomically, and may in-fact allow creation of a smaller gastric pouch than in open surgery. Additional long-term prospective studies are needed to help correlate this information with weight loss and complication data.