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Keith Kreitz, MD; Peter F. Rovito, MD

Arch Surg. 2003;138:707-709.

Hypothesis  Laparoscopic Roux-en-Y gastric bypass is a safe and effective procedure in patients with a body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters) of 70 or greater.

Design  A retrospective analysis of patients with a BMI of 70 or greater who underwent laparoscopic Roux-en-Y gastric bypass by a single surgeon.

Setting  A university-affiliated community hospital in Allentown, Pa.

Patients  A nonconsecutive series of 9 patients with a BMI of 70 or greater who met traditional criteria for a bariatric procedure.

Intervention  Laparoscopic approach to Roux-en-Y gastric bypass with stapled anastomoses.

Results  Patient medical records were reviewed for length of stay, complications, operative time, comorbidities, and weight loss. Seven patients were women and 2 were men. Comorbidities included dyspnea on exertion, peripheral edema, arthritis, sleep apnea, hypertension, diabetes mellitus, asthma, hypothyroidism, gastroesophageal reflux disease, peptic ulcer disease, and heart disease. Eight of 9 procedures were successfully completed laparoscopically. One patient was converted to an open procedure. One patient developed a marginal ulcer postoperatively. No other complications occurred. Operative time ranged from 122 to 330 minutes (mean, 203 minutes). Length of stay averaged 1.2 days. Overall weight loss was 49% of excess body weight at 1 year after surgery.

Conclusion  Laparoscopic Roux-en-Y gastric bypass is safe and effective in patients with a BMI of 70 or greater.

From the Departments of Surgery, Lehigh Valley Hospital, Allentown, Pa (Drs Kreitz and Rovito), and Penn State University, Hershey, Pa (Dr Rovito).

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