Process optimization of laparoscopic gastric bypass operation        LIANG Hui, GUAN Wei, WU Hong-hao, et al. Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029,China
Corresponding author: LIANG Hui, E-mail: drhuiliang@126.com
Abstract    Objective    To compare two laparoscopic gastric bypass operation processes for optimization of the appropriate operation procedure for Chinese obese patients. Methods    A total of 80 obese patients underwent laparoscopic gastric bypass from May 2010 to May 2012 at the First Affiliated Hospital of Nanjing Medical University. There were two operative processes including the Cleveland Clinic Foundation (CCF) approach (n=30) and the Nanjing Medical University (NJMU) approach (n=50). All patients were followed up and surgical videos were reviewed. The operative time, the number of position change, the number of surgical steps and the number of technical errors occurred intraoperatively and postoperatively, and excess weight lose rate (% EWL) were compared between the two groups. Results    In CCF approach, position change was required 4 times, while NJMU approach required twice. The mean operative time was 117min for the NJMU approach and 194 minutes for the CCF approach, and the difference between the two approaches was statistically significant (P<0.05). The main steps with the right hand was 97 times in the CCF approach and 76 times in the NJMU approach, and the difference between the two approaches was statistically significant (P<0.05). Confusion of the food limb and biliary-pancreatic limb occurred twice in the CCF approach, while no intestinal loop confusion occurred in the NJMU approaches. The difference in EWL was not statistically significant between the two groups (P>0.05). Conclusion    The NJMU approach is more suitable for Chinese obese patients, which can reduce the steps of the laparoscopic gastric bypass, decrease operative time, minimize the potential intraoperative complications.