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Pouch Problems More Common With Laparoscopic Bypass Technique

Nov. 6, 2003 -- A new study outlines the risks of laparoscopic gastric bypass surgery, coinciding with the death of a 38-year-old woman in Boston who had the surgery two days earlier.

Ann Marie Simonelli, 38, died in October after having her stomach stapled in the procedure, according to news reports.

Gastric bypass surgery is the most commonly performed operation for the treatment of morbid obesity. It reduces the size of the stomach and can cause malabsorption of nutrients, leading to weight loss. Since the first published case of the laparoscopic approach to this technique, the advantages have been publicized: less blood loss, shorter length of hospitalization and earlier discharge, and faster recovery.

Another well-known advantage: reduction of complications related to the wound, since the incision is smaller.

However, the postoperative complications of laparoscopic gastric bypass surgery have not been as widely publicized, writes lead researcher Yale D. Podnos, MD, MPH, with the University of California-Irvine Medical Center. His findings are published in the September 2003 issue of Archives of Surgery.

Podnos and his researchers reviewed 10 studies of 3,464 patients who had the laparoscopic technique for gastric bypass surgery and eight studies of 2,771 patients who underwent the open surgery procedure for gastric bypass.

In the open surgery procedure, a large incision is made in the abdomen. In laparoscopic gastric bypass surgery, a small incision is made.

Although there was a lower rate of wound infections, hernias, and death with the laparoscopic technique, there was also a higher frequency of bowel obstruction, gastrointestinal tract hemorrhage, and narrowing of the stomach pouch that is created, Podnos reports.

Also, the researchers reported that more leaks occurred at the site where the bypass is created after the laparoscopic procedure than the open surgery procedure. Often, leak rate is related to the surgeon's experience, he notes.

Narrowing of the stomach pouch happens more frequently with laparoscopic gastric bypass surgery, possibly related to the mechanical stapler that is used to close the newly created smaller stomach; with the open procedure, the pouch is hand-sewn, writes Podnos.

Open-incision gastric bypass surgery can, in rare causes, involve injury to the spleen, which has never been reported with the laparoscopic procedure, Podnos says. Wound infection and hernia at the incision site are common complications after the open procedure but are manageable.

"Our findings suggest that surgeons must learn the proper techniques of laparoscopic gastric bypass surgery and have adequate training before performing this complex laparoscopic operation," Podnos writes.

SOURCE: Podnos, Y. Archives of Surgery, September 2003; vol 138: pp 957-961.

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