Department of Anaesthesia, Central Manchester University Hospital, Oxford Road, Manchester, M13 9WL, UK.
Obes Surg. 2012 Mar;22(3):398-402. doi: 10.1007/s11695-011-0473-3.
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a potentially complicated surgery with significant hospitalisation, especially during the learning curve. There are inadequate data on fast-track LRYGB in relation to learning curve. This study highlights the outcomes of a fast-track LRYGB service.
This observational study examined the perioperative outcome data of 406 consecutive LRYGB patients over a 4-year period. Perioperative outcome data were analysed and compared between severe obesity, morbid obesity and super obesity groups.
Mean BMI was 48.6 ± 8.3, mean age was 42 years and male to female ratio was 1:4. About 4% of patients had concurrent ventral hernia repair. Median duration of combined LRYGB and ventral hernia repair was 115 min, compared to 95 min for LRYGB alone (p = 0.09). Intraoperative complication rate was 0.5%. Postoperative complications occurred in 3.4% of patients with 60% within 24 h. The complication rate per obesity group was <7% and similar between groups (p = 0.4). There was no perioperative mortality. More super obese patients received postoperative intensive care compared to others (p = 0.001). Mean length of hospital stay was similar between obesity groups and decreased from 2 to 1 day over 2 years. There was a learning curve of 109 cases over 2 years.
LRYGB is a safe technique of bariatric surgery with low risk of perioperative complications. Establishing a fast-track LRYGB service requires a learning curve of 100 cases, and a good indicator is length of hospital stay, which decreases as the service matures. Most LRYGB patients can be safely discharged by 24 h.
腹腔镜 Roux-en-Y 胃旁路术（LRYGB）是一种潜在复杂的手术，需要大量住院治疗，尤其是在学习曲线期间。关于快速通道 LRYGB 与学习曲线相关的数据不足。本研究强调了快速通道 LRYGB 服务的结果。
本观察性研究检查了 4 年内 406 例连续 LRYGB 患者的围手术期结果数据。分析并比较了严重肥胖、病态肥胖和超级肥胖组的围手术期结果数据。
平均 BMI 为 48.6±8.3，平均年龄为 42 岁，男女比例为 1:4。约 4%的患者同时患有腹疝修补术。LRYGB 和腹疝修补术联合的中位时间为 115 分钟，而 LRYGB 单独的中位时间为 95 分钟（p=0.09）。术中并发症发生率为 0.5%。术后并发症发生在 3.4%的患者中，60%发生在 24 小时内。每组肥胖患者的并发症发生率均<7%，且组间相似（p=0.4）。无围手术期死亡。更多的超级肥胖患者在术后接受了重症监护，与其他患者相比（p=0.001）。肥胖组之间的住院时间相似，并且在 2 年内从 2 天减少到 1 天。2 年内有 109 例的学习曲线。
LRYGB 是一种安全的减肥手术技术，围手术期并发症风险低。建立快速通道 LRYGB 服务需要 100 例的学习曲线，而作为服务成熟的一个良好指标是住院时间，随着服务的成熟而减少。大多数 LRYGB 患者可以在 24 小时内安全出院。
