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Surgical Method

Safety in Numbers

Tuesday, April 19, 2005; Page HE02

The standard gastric bypass operation for morbid obesity is difficult enough when performed in the conventional "open" manner: A surgeon makes a six- to eight-inch incision in the abdomen and then reduces the size of the stomach, working deep in the abdominal cavity amid massive amounts of fat. How much trickier is it to do the operation laparoscopically -- through a series of pencil-sized incisions into which surgeons thread instruments and a mini-camera? That question has become more critical as demand has grown for the less-invasive method, which shortens patient recovery time.

Magic Number A new study by a team of surgeons at Tufts-New England Medical Center in Boston suggests that the learning curve for a laparoscopic Roux-en-Y operation, the most common weight loss surgery, may be at least 100 cases. That's the number the team needed to significantly reduce the rate of death and serious complications, including a bowel obstruction, according to an analysis of 750 patients who underwent the procedure at the hospital between 1998 and 2004. The study, led by surgeon Scott A. Shikora, appears in the current issue of the Annals of Surgery.

Practice Makes Perfect? For the first 100 cases, the death rate was about 1 in 100 and the rate of complications was 26 percent. After 100 cases, the death rate dropped to 1 in 200 and the rate of complications to 13 percent.

Officials at the American Society for Bariatric Surgery estimate that about half of gastric bypass operations are now performed laparoscopically. Despite a stampede of surgeons eager to perform gastric bypass, which increased nationally from 29,000 procedures in 1999 to nearly 141,000 in 2004, the operation is "generally considered to be one of the more technically challenging laparoscopic procedures," compounded by the problem of seeing organs clearly, Shikora wrote.

-- Sandra G. Boodman

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