Fast-track laparoscopic gastric bypass surgery: outcomes and lessons from a bariatric surgery service in the United Kingdom.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.