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IFSO 2010. 2000 Fast Track Laparoscopic Bypass Procedures. Jens Fromholt Larsen, MD,Ph.D.Uffe Raundahl, MDThorbj
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1. IFSO 2010
2. IFSO 2010
3. IFSO 2010 Private Hospital Mølholm 25 specialities
30 beds
4.500 operations in general anesthesia per year
4. IFSO 2010 Bariatic ProgramPrivate Hospital Mølholm Preoperative group education
Multidisciplinary evaluation
Preoperative treatment, 8% - 10 %weight loss, 2-4 months
Operation, one day stay
Follow-up and documentation
1,4,12 months,incl. Moorehead questionnaire
2, 3,4,5..10 years
5. IFSO 2010 Preoperative group educationPatients and relatives Preoperative education
Individual evaluation
Endocrinologist
Surgeon
Dietician
Interaction with patients who have undergone bariatic surgery
6. IFSO 2010 In-hospital approach Admission 2 hours before surgery
Low-molecular-weight heparin
5000 four hour postop.
Antibiotics peroperatively
Cefuroxim 1.5 g
Metronidazol 1 g
7. IFSO 2010 Surgery
Staff
One surgeon
Two dedicated scrub nurses
Linear Stapled Double Loop Technique
No drainage
No tubes
8. IFSO 2010 Postoperative management Recovering at the ward
Monitoring
pulsoximetry,
telemetry,
peripheral arterial catheters
Early mobilization,
2 hours postop
Immediate oral intake
Fluid
Soup
9. IFSO 2010 Discharge teaching Discharge 1. postoperative day before 11 a.m
Oral and written information
Postoperative medication
Symptoms and signs of early and late complications
Dietary information
Wound care
Physical activity
Follow-up
Contact information, emergent and nonemergent call
10. IFSO 2010 Bariatic SurgeryPrivate Hospital Molholm First operation 1. January 2006
> 3000 procedures 99% lap. bypass
1. January 2007 introduced fast track one day stay
1. August 2007 propective registration:
In hospital stay
Time of leaving to operation room
Time of return to ward
Time of mobilization
Time of discharge
In-hospital complications
Patient self assessement
Operation
Operative time
Peroperative complications
Follow up 1, 4 and 12 months and
yearly questionare and blodtest
Re-admission, complications , satisfaction, QoL
Validation of follow-up data by checking for readmission in the danish registry of
11. IFSO 2010 Validation of follow-up data All patiens operated and discharged from Privatehospitale Molholm was checked for readmissions in the Danish Register for Patients
ICD, procedure code, and time for readmission was recorded and compared with our data
12. IFSO 2010 Laparoscopic Gastric BypassHospital Mølholm
13. IFSO 2010 Material prospective consecutive Laparoscopic Bypass, fast trackPeriode 01.08.2007-06.03.2010
14. IFSO 2010 Operative time time skin incision – skin closure, minutes
15. IFSO 2010 Time returning to ward and mobilization
16. IFSO 2010 Discharge
17. IFSO 2010 Patient assessment, N= 2000 Time of discharge
18. IFSO 2010 Patient Assessment, N = 2000 In-hospital stay
19. IFSO 2010 Perioperative complications In-hospital, re-operation
20. IFSO 2010 Complications within 4 monthsRe-admission after discharge
21. IFSO 2010 Quality of LifeMoorehead Questionnaire
22. IFSO 2010 Conclusion Laparoscopic Fast Track Gastric By-pass Feasible
Low in-hospital reoperation rate
Low re-admission rate
Low mortality
High patient satisfaction