Laparoscopic Roux-en-Y gastric bypass: Preoperative determinants of prolonged operative times, conversion to open gastric bypasses, and postoperative complications

Background: We examined our database of 600 consecutive laparoscopic Roux-en-Y gastric bypasses (LRYGBP) to determine predictors of prolonged operations, conversion to open operations and postoperative complications. Methods: All were primary bariatric operations. Body habitus, gender, and previous surgery were evaluated. Results: Regression analysis showed the following parameters to correlate positively with increased operative time: 1) Waist, 2) BMI, 3) Weight, and 4) Waist/Hip ratio. Height and hip measurement did not correlate with operative time. No previous operations affected operative time. Conversion to open operation was necessary in 25/600 cases (4.2%). Conversion was necessary with larger waist measurement (P=0.00007) and increased waist/hip ratio (P=0.01) but not BMI. Conversion occurred more frequently in males (6/43, 14.0%) than females (19/557, 3.4%). This trend was statistically significant (P=0.006). An enlarged liver was responsible for 12/25 conversions. 6/12 patients with large livers had type II diabetes and 6/12 patients had biopsy-proven steatohepatitis. 2/12 had huge yellow-brown livers that were not biopsed. Liver function tests were normal in 8/8 patients preoperatively. Complications including leak (5), pulmonary embolus (2), hemorrhage (12), stenosis of the GI tract (24) and infection (7) occurred in 48/600 patients (8.0%). There were no deaths. Complications did not correlate with body habitus, gender, or previous surgery. Conclusion: Larger patients as measured by waist measurement, weight, and BMI but not previous surgery prolonged LRYGBP. Conversion to open surgery was more frequently necessary in patients with larger abdomens, central obesity, and type II diabetes. Complications did not correlate with any preoperative parameter measured.