The study -- the first to evaluate how well patients fare from the surgery -- calls for more training of surgeons in the use of laparoscopy in surgery for the morbidly obese, as the minimally invasive techniques become more common. The study was presented at the recently held annual convention of the American College of Surgeons in San Francisco.
Dr. Ninh T. Nguyen, associate professor of surgery and chief, division of gastrointestinal surgery at UCI Medical Center, and his colleagues found that patients who underwent the surgery, known as laparoscopic gastric bypass, had a shorter operative time, reduced hospital stay and fewer complications when the surgeon had performed more than 75 procedures. The study also found that men and older patients were more susceptible to postoperative problems.
Patients in the study were considered morbidly obese with a body-mass index between 39 and 61. Currently a body-mass index greater than 25 is considered overweight and a body-mass index greater than 30 is considered obese.
Laparoscopic gastric bypass is becoming a popular technique for treating people who are morbidly obese. The new method shortens recovery time and reduces the risk of infection posed by traditional open surgeries. It involves making five small abdominal incisions. Then, a tiny scope and other instruments are inserted into the abdominal cavity. Part of the upper stomach is stapled to create a small pouch and the small intestine is rerouted and connected to the new pouch. About 57,000 Americans are expected to have either the traditional or laparoscopic operation this year.
"Laparoscopic gastric bypass is becoming a mainstream method for treatment of morbid obesity, which is increasing rapidly in the United States. For many patients this is the only viable option," Nguyen said. "But this study shows that experience in this complex procedure translates to better clinical outcomes. A surgeon who had performed at least 75 operations of this type had a dramatic decrease in postoperative complications. While this is a fact of all surgeries, it's especially important here because the learning curve is quite high, and this issue needs to be addressed by medical societies."
Nguyen, who performed 150 consecutive operations at UC Davis for this study, and his colleagues found that the first 75 cases had nine complications and nine reoperations compared to one each in the last 75 cases. Seventeen percent of the patients in the first 75 cases stayed in the hospital more than four days compared to only 4 percent in the last 75. In addition, 38 percent of patients older than 50 had complications compared to 10 percent of those younger than 50. Being male was associated with more complications, which Nguyen suspects is due to the propensity for male fat to accumulate in the abdomen, making surgery more difficult to perform.
Nguyen, who recently arrived at UCI, performs gastric bypass and other minimally invasive stomach surgeries at UCI Medical Center. He also is conducting research on the effectiveness and safety of a recently approved adjustable gastric-banding device.
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