Authors: Markus K Müller Josef Guber Stefan Wildi Ivo Guber PierreAlain Clavien Markus Weber
Publish Date: 2007/07/06
Volume: 17, Issue: 7, Pages: 889-893
Abstract
Since 1994 laparoscopic RouxenY gastric bypass LRYGBP has gained popularity for the treatment of morbid obesity In analogy to open surgery the operation was initially performed in a retrocolic fashion Later an antecolic procedure was introduced According to shortterm studies the antecolic technique is favorable In this study we compared the retrocolic vs the antecolic technique with 3 years of followup We hypothesized that the antecolic technique is superior to the retrocolic in terms of operation time and morbidity33 consecutive patients with retrocolic technique and 33 patients with antecolic technique of LRYGBP were compared using a matchedpair analysis Data were extracted from a prospectively collected database The matching criteria were BMI age gender and type of bypass proximal or distal The endpoints of the study were operation time length of hospital stay incidence of early and late complications reoperation rates and weight loss in the followup over 36 monthsIn the retrocolic group operation time was 219 min compared to 188 min in the antecolic group P = 0036 In the retrocolic group 3 patients 91 developed an internal hernia and 4 patients 121 suffered from anastomotic strictures In the antecolic group 2 patients 61 developed internal hernias and in 3 patients 91 anastomotic strictures occurred Median hospital stay in the retrocolic group was 8 days compared to 7 days in the antecolic group In the antecolic group the mean BMI dropped from 46 kg/m2 to 32 kg/m2 postoperatively after 36 months This corresponds to an excess BMI loss of 66 In the retrocolic group we found a similar decrease in BMI from preoperative 45 kg/m2 to 34 kg/m2 after 36 months P = 0276The results of our study demonstrate a reduction of operation time and hospital stay in the antecolic group compared to the retrocolic group No differences between the two groups were found regarding morbidity and weight loss Taken together the antecolic seems to be superior to the retrocolic technique
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