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Laparoscopic Roux-En-Y Gastric Bypass for Morbid Obesity 2Nd Edition

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Laparoscopic Roux-En-Y Gastric Bypass for Morbid Obesity 2Nd Edition ® LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS FOR MORBID OBESITY 2nd Edition Rudolf A. WEINER ® LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS FOR MORBID OBESITY 2nd Edition Rudolf A. WEINER Center for Minimally Invasive Surgery Sachsenhausen Hospital, Frankfurt am Main, Germany 4 Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity The anatomical and surgical Laparoscopic Roux-en-Y Gastric Bypass illustrations were made by: for Morbid Obesity Mr. Harald Konopatzki, 2nd Edition Grünewaldstrasse 3a, D-69126 Heidelberg, Germany Rudolf A. Weiner E-mail: [email protected] Center for Minimally Invasive Surgery Sachsenhausen Hospital, Frankfurt am Main, Germany Correspondence address of the author: Prof. Dr. med. Rudolf Weiner Zentrum für minimal invasive Chirurgie Krankenhaus Sachsenhausen, Frankfurt am Main Schulstrasse 31 D-60594 Frankfurt am Main, Germany Phone: +49 69 / 66 05-11 99 Fax: +49 69 / 66 05-15 30 Important notes: Internet: http://www.khs-ffm.de Medical knowledge is ever changing. As new research and clinical http://www.prof-weiner.com ­experience broaden our knowledge, changes in treat­ment and E-mail: [email protected] therapy may be required. The authors and editors of the material herein have consulted­ sources believed to be reliable in their efforts to ­provide information that is complete and in accord with the ­standards All rights reserved. accept­ed at the time of publication. However, in view of the ­possibili­ty 2nd edition 2006 | 1st edition 2004 of human error by the authors, editors, or publisher, or changes in © 2015 ® GmbH medical knowledge, neither the authors, editors, publisher­ , nor any P.O. Box, 78503 Tuttlingen, Germany other party who has been involved in the preparation of this booklet, Phone: +49 (0) 74 61/1 45 90 warrants that the ­information ­contained herein is in every respect Fax: +49 (0) 74 61/708-529 accurate or complete, and they are not responsible for any errors or E-mail: [email protected] omissions or for the results obtained from use of such information. The information contained within this booklet is intended for use No part of this publication may be translated, reprinted by doctors and other health care professionals. 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The use of this booklet as well as any implementation of the information contained within explicitly takes place at the reader’s Design and Composing: own risk. No liability shall be accepted and no guarantee is given ® GmbH, Germany for the work neither from the publisher or the editor nor from the author or any other party who has been involved in the preparation of this work. This particularly applies to the content, the timeliness, Printing and Binding: the correctness, the completeness as well as to the quality. Printing Straub Druck + Medien AG errors and omissions cannot be completely excluded. The publisher Max-Planck-Straße 17, 78713 Schramberg, Germany as well as the author or other copyright holders of this work disclaim any liability, particularly for any damages arising out of or associated 06.15-1.2 with the use of the medical procedures mentioned within this booklet. Any legal claims or claims for damages are excluded. 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ISBN 978-3-89756-515-9 Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity 5 Table of Contents 1.0 Introduction ........................................................ 6 What is the annual cost of obesity in the US? ............................ 7 Comorbidities? ...................................................... 8 1.1 Operative Procedures in Bariatric Surgery . 8 1.2 Indications for Surgery Body Mass Index................................................ 9 2.0 Historical Background of the Roux-en-Y Gastric Bypass ................... 10 3.0 Laparoscopic Roux-en-Y Gastric Bypass ............................. 10 4.0 Technique .......................................................... 11 4.1 Gastrojejunostomy .............................................. 15 4.1.1 Circular Stapler Anastomosis............................ 16 4.1.2 Linear Stapler Anastomosis ............................. 19 4.1.3 “Hand-Sewn” Anastomosis ............................. 19 4.2 Jejuno-Jejunal Anastomosis ...................................... 20 4.3 Postoperative Phase............................................. 22 5.0 Results ............................................................. 22 5.1 Mortality ....................................................... 23 5.2 Morbidity....................................................... 24 5.3 Conversion Rate ................................................ 24 5.4 Reasons for Conversion.......................................... 24 Gastric bypass studies concerning operating times and duration of stay at clinic ................................. 25 5.5 Excess Weight Loss ............................................. 27 5.6 Improvement of Comorbidities .................................... 27 5.7 Quality of Life (QoL) ............................................. 28 5.8 Simultaneous Cholecystectomy?......................... 29 6.0 Complications 6.1 Hemorrhage ............................................... 29 6.2 Anastomotic Insufficiency ........................................ 30 6.3 Wound Infection ................................................ 30 6.4 Postoperative Hemorrhage ................................... 30 6.5 Anastomotic Stenosis (Gastrojejunostomy) ......................... 31 6.6 Anastomotic Stenosis (Entero-Enteric Anastomosis)................ 31 6.7 Deep Vein Thrombosis ....................................... 31 6.8 Anastomotic Ulcer .......................................... 32 6.9 Internal Hernias and Small Intestine Environment .................... 32 6.10 Fistulas and Abscesses ...................................... 33 6.11 Postoperative Incisional Hernia ................................... 33 6.12 Wernicke’s Syndrome............................................ 34 6.13 Iron Deficiency .................................................. 34 6.14 Hyperparathyroidism ........................................ 34 References ....................................................... 35 6 Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity 1.0 Introduction Overweight is spreading throughout all countries so surgical intervention should be implemented at an earlier obesity is a worldwide problem: It is the heavy burden of stage if conservative therapy has failed. There are several affluent society. For the first time there are just as many reasons for the epidemic increase in obesity, including fat people on earth as slim people: 1.1 billion people are changing lifestyle habits (excessive intake of food rich in starving every day – compared with 1.1 billion overweight calories/fat and lack of physical activity) which interact individuals, and the trend is on the increase. The World with genetic predispositions and thus lead to an increase Health Organization, WHO, describes obesity as the in the body’s fat content. most serious chronic health problem at present. In some western industrial countries over 50% of the population The objectives of obesity therapy are as follows: is overweight. In Germany the figure has now reached l To reduce energy intake, 52.4%. 9 million Germans are suffering from obesity l to increase the patient’s energy consumption, requiring treatment. Depending on the particular country, l and thus help the body to achieve a new energy obesity and its sequelae account for 5%-10% of the total balance. cost of the healthcare system. For women the mortality risk is doubled by morbid obesity with a BMI of > 40 kg/ m2 and for men it is tripled. The earlier obesity occurs, the Obesity is a chronic disease and should not be merely sharper the rise in mortality risk. regarded as a biological variant. Obesity and its sequelae account for approximately According to an analysis for 1993 in the Federal Republic 280,000 deaths a year in the US. As a result, overweight is of Germany, commissioned
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