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Laparoscopic Surgery Better Than Open Gastric Bypass Surgery

Compared with open gastric bypass surgery, performing the procedure laparoscopically reduces postoperative complications as well as the need for reoperation and is associated with a shorter hospital stay, new research shows. Nevertheless, laparoscopic gastric bypass does incur higher total costs. The study, analyzed data for 19,156 subjects who underwent gastric bypass surgery in 2005 and were logged in the Nationwide Inpatient Sample, the largest all-payer inpatient database in the US.

Slightly less than 75% of the patients underwent laparoscopic gastric bypass, report co-authors Dr. Wendy E. Weller, from the University at Albany in New York, and Dr. Carl Rosati, from Albany Medical Center.

Laparoscopic gastric bypass was linked to a reduced risk of several complications. With open surgery, the odds ratio for pulmonary complications was 1.92, for cardiovascular complications it was 1.54, for sepsis it was 2.18, and for anastomotic leak, 1.32 (p < 0.05 for all).

On average, performing laparoscopic rather than open gastric bypass reduced the hospital stay by about 1 day (p < 0.001).
Average total charges were similar for the two procedures, but median total charges were significantly higher with laparoscopic gastric bypass: $30,033 vs. $28,107 (p < 0.001).

After accounting for various patient and hospital factors, laparoscopic surgical patients were less likely than their open-surgery counterparts to require reoperation, the investigators found.

While the current findings suggest some advantages with the laparoscopic operation, "most reassuring for the bariatric surgery community is that the hospital outcomes were excellent overall in both the laparoscopic and open procedures," Dr. Michael G. Sarr, from the Mayo Clinic in Rochester, Minnesota, comments in a related editorial.

"Not only were serious morbidities low in both the open and laparoscopic groups, but operative mortalities were < 0.3%," he adds. "Therefore, this study reinforces the in-hospital safety of Roux-en-Y gastric bypass whether done open or laparoscopically and suggests overall…that most bariatric procedures throughout many diverse practices in the US are being done well."

Ann Surg 2008;248:10-17.

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