The nature of complications after open Roux-en-Y gastric bypass (GBP) have evolved with advancements of laparoscopic technique. In the United States the number of laparoscopic gastric bypass operations being performed has increased considerably during the last few years. Studies comparing laparoscopic gastric bypass operations and open gastric bypass operations show that laparoscopic gastric bypass operations are related with decrease of complications of iatrogenic splenectomy, wound infection, incisional hernia, and mortality but an increase in the frequency of bowel obstruction, gastrointestinal tract haemorrhage, and stomal stenosis.
The wound related complications refer to infection and hernia which are less prevalent in cases operated by laparoscopic gastric bypass technique. Open gastric bypass operations are often associated with high incidences of splenic injury due to traction injury inflicted upon short gastric vessels while operating or also from capsular tear by retractors. Better field of vision in the site of operation while performing laparoscopic gastric bypass surgeries result in less incidence rates of splenic injury.
Wound infection is uncommon in laparoscopic gastric bypass operations obviously because of minimal requirement of incision at the operating site. Likewise incidence rates of incisional hernia is less in patients undergoing laparoscopic gastric bypass surgeries as compared to� open gastric bypass operations� due to small size of incision in laparoscopic gastric bypass surgeries. In patients on whom laparoscopic gastric bypass surgeries are performed there is less probability for retained instruments and laparotomy pads inside the body as it is highly unlikely to insert instruments and laparotomy pads through a trocar.
The probability of postoperative GI tract bleeding is higher after laparoscopic than after open gastric bypass operations.GI tract bleeding is probably from the gastric remnant, the gastrojejunostomy, or the jejunojejunostomy staple-line. Theoretically laparoscopic gastric bypass surgeries should result in reduction in cases of bowel obstruction due to reduction in adhesion formation. But practically it is generally observed that complications of early and late bowel obstruction is higher after laparoscopic gastric bypass surgeries. The reason for the increased incidence of bowel obstruction can be related to the high requirement of expertise in construction of the jejunojejunostomy.
The hand-sewn technique is often used for creation of the gastrojejunostomy in open gastric bypass surgeries which may be helpful in reducing chances of bleeding. However it can also be because of the inexperience of the surgeon performing laparoscopic gastric bypass surgeries which can cause more incidents of gastrointestinal tract haemorrhage. Laparoscopic gastric bypass surgeries are associated with higher incidence of stomal stenosis and a lower frequency of death. However the reason behind this is still not confirmed. Though there are no major differences in the recurrence rates of anastomotic leak, pulmonary embolism, or pneumonia.
The nature and recurrence of postsurgical complications after laparoscopic gastric bypass operations and open gastric bypass operations vary a lot. Some complications increase with laparoscopic gastric bypass operations which can be attributed to the high level of complexity of this procedure. On the other hand other complications are less apparent due to the benefits of smaller access incision. So modern day surgeons must learn and keep up to date on latest techniques of laparoscopic gastric bypass surgeries and have sufficient experience before operating laparoscopic gastric bypass surgeries. Hence professional bodies and associations play a major role in providing training programs to the surgeons who wish to perform laparoscopic gastric bypass surgeries.
For more information:
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