Source: Banka G. Arch Surg. 2012;147:550-556.
July 05, 2012
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Laparoscopic gastric bypass surgery showed safer results than open procedure

Source: Banka G. Arch Surg. 2012;147:550-556.
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Laparoscopic Roux-en-Y gastric bypass showed lower rates of complications, length of hospital stay, charges and mortality compared with open Roux-en-Y gastric bypass in the treatment of morbidly obese patients.

Based on data from a retrospective cohort study conducted from 2005 to 2007, Gaurav Banka, MD, and colleagues sought to determine national outcome differences between the two gastric bypass surgeries. The researchers used data from the Nationwide Inpatient Sample (NIS), a database that contains information on 5 million to 8 million inpatient stays from roughly 100 hospitals from 37 states.

According to collective data from the NIS, 115,177 patients underwent laparoscopic Roux-en-Y (LRYGB) and 41,094 patients had open Roux-en-Y (ORYGB) from 2005 to 2007. Their median age was 42.7 years (75% white, 82.5% women). 

“Obesity has been associated with numerous adverse health conditions, including diabetes mellitus, cardiovascular disease, nonalcoholic liver disease, increased risk of disability, hypertension, dyslipidemia, some forms of cancers, gallstones, and musculoskeletal disorders,” researchers wrote. “Bariatric surgery has proven to be the most effective and enduring option in treating the morbidly obese.”

They report that a larger proportion of ORYGB compared with LRYGB patients were discharged with nonroutine dispositions (7.7% vs. 2.4%), died (0.2% vs. 0.1%) and had at least one complication (18.7% vs. 12.3%).

Moreover, patients who underwent ORYGB compared with patients who had LRYGB experienced longer hospital lengths of stay on average (3.5 days vs. 2.4 days; P<.001), as well as higher total charges related to the procedure ($35,018 vs. $32,671; P<.001).

Researchers found LRYGB to be more commonly administered compared with ORYGB (72% vs. 28%; P,.001) at high-volume hospital settings (69% vs. 61%; P,.001). Additionally, most patients who underwent ORYGB were covered by Medicare and Medicaid.

Using Elixhauser comorbidity measures, researchers said they found higher rates in ORYGB compared with LRYGB patients for: cardiac arrhythmia (5.76% vs. 4.26%; P=.008), congestive heart failure (2.03% vs. 1.43%; P=.002), diabetes complicated (1.74% vs. 1.2%; P=.01), pulmonary circulatory disorders (0.92% vs. 0.47%; P=.001) and peripheral vascular disorders (0.46% vs. 0.3%; P=.07).

“Laparoscopic gastric bypass was highly protective for mortality (OR=0.54; P<.001), one or more complications (OR=0.66; P,.001), and nonroutine disposition (OR=0.43; P<.001),” researchers said. However, an increase in complications was associated with patients aged 60 years and older (OR=2.174; <.001).

They concluded that a laparoscopic approach is beneficial in terms of safety vs. ORYGB surgery.

Disclosure: The researchers report no relevant financial disclosures.