Laparoscopic Bariatric Surgery
Peter LePort (Gastric Bypass Surgeon) gives expert video advice on: What is 'laparoscopic bariatric' bypass surgery?; Can laparoscopic bariatric surgery be dangerous or fatal?; Who is eligible to get laparoscopic bariatric bypass surgery? and more...
What is 'laparoscopic bariatric' bypass surgery?
Laparoscopic bariatric surgery, we will talk about it in general. Laparoscopic surgery - another name for it is minimally invasive surgery. And what we do is we make small holes in the abdominal wall that we put instruments in. Those holes are maybe a half an inch, sometimes a quarter of an inch and they could be an inch or an inch and a half depending on which procedure we are using. We then put a camera in and instrumentation through the various ports that we have placed. And we actually do the operation on a TV set, on a monitor. So in a way, it sounds funny, it is a video game. We are playing a video game but this is actual real life. We are actually doing it but watching it on a monitor.
Can laparoscopic bariatric surgery be dangerous or fatal?
The morbidity and mortality rate for laparoscopic in somebody who is experienced, they've done more than a hundred maybe more than two or three hundred cases is the same as the open procedure. Just to review, death certainly occurs, the rate is about the same, two to four in a thousand. Leaks are about the same. Pulmonary embolas, I haven't see studies yet on it, I'm assuming they are going to actually go down because the patient gets around much faster and much easier but pulmonary embolas is a big problem with any surgery and very big with bariatric surgery so if that proves to be less with laparoscopic than that will be a big advantage to having it done laparoscopic ally.
Who is eligible to get laparoscopic bariatric bypass surgery?
The choice of is it going to be laparoscopic or is it going to be open really depends; first if the patient is demanding one or the other, and the second, what are the conditions, the medical conditions of the patient. A lot of the contrary reasons to doing the surgery, like somebody who has a bleeding disorder would be whether it would be open or laparoscopic. The only real time I would not do a patient laparoscopic ally would be if they've had multiple, multiple interdominal surgeries, especially gastric surgeries.
What are the advantages of laparoscopic bariatric bypass surgery?
The advantages of not having that big incision. So, the pain, which patients usually have with open procedures, is minimalized, very small compared to what it is with the laparoscopic procedure. The procedures are slightly different because we're using instrumentation and we can't put our hands inside the abdomen to do that, but the procedures basically are the same. The gastric bypass, whether done open or laparoscopically, have the same complication rates, the same success rates. It's all a matter of where doing this through small holes is better for the patient. One of the good things is they get out of the hospital a day or two earlier than they would if we did it open. Same thing with the laparoscopic adjustable gastric band which once in awhile we'll put in open, but most of the time, almost 100% of the time, we do it laparoscopically. That band which has replaced the vertical band of gastroplasty means no open procedure, less time in the hospital, less pain for the patient.
What are the disadvantages of laparoscopic bariatric bypass surgery?
There are definitely disadvantages to the laparoscopic surgery. First, for the surgeon, is the learning curve. “What does it take to learn how to do that” is much longer than an open procedure. I have taught several surgeons how to do bariatric surgery, and teaching the open procedure... the surgeon gets it within five to ten cases. We're talking about laparoscopic, fifty to a hundred, maybe, two-hundred cases to become as proficient as with the open procedure. Obviously everybody started with open laparoscopic started in the mid to late nineties and really took off in the 2000's. And those surgeons who are being trained now are being trained laparoscopically to begin with. The other disadvantage is we actually don't have our hands, we can't feel what's going on inside the abdomen. The procedure itself does not make any difference, but there are times in all those procedures I've done, my whole group--5000 procedures, where we've found tumors and other problems by just feeling what's going on. We're not going to be able to do that with laparoscopic. That, to me, is minor, because you don't find something very frequently and the advantage of laparoscopic is much better.