Outcomes after Open vs Laparoscopic Gastric Bypass

Abstract & Commentary

By Richard Peterson, MD, MPH, Clinical Instructor of Surgery, Department of Surgery, USC. Dr. Peterson reports no financial relationship relevant to this field of study.
This article was peer reviewed by Peter Crookes, MD, FACS

Synopsis: LGB is associated with significantly lower mean hospital stay and with reduced morbidity and mortality as compared with OGB.

Source: Ricciardi R, et al. Outcomes after open versus laparoscopic gastric bypass. Surg Laparosc Endosc Percutan Tech. 2006;16:317-320.

In expert hands, laparoscopic gastric bypass (LGB) is associated with reduced morbidity and mortality compared with open bariatric surgery. The purpose of our study was to determine whether or not the results of LGB have been realized in the general US population. We used data from the nationwide inpatient sample to define differences in outcomes after LGB versus open gastric bypass (OGB). We calculated hospital stay, in-hospital mortality, and major complications for both OGB and LGB. We noted a total of 26,940 gastric bypass procedures: LGB was coded in 16.3% and OGB in 83.7%. The mean hospital stay, mortality, wound, gastrointestinal, pulmonary, and cardiovascular complications were significantly lower after LGB (P < 0.001). After we adjusted for covariates, hospital stay, pulmonary morbidity, and mortality remained significantly lower after LGB (P < 0.001). In conclusion, LGB is associated with significantly lower mean hospital stay and with reduced morbidity and mortality as compared with OGB.

Ricciardi and colleagues presented a very nice paper comparing the results of laparoscopic gastric bypass (LGB) versus open gastric bypass (OGB). The aim of their study was to evaluate data from centers that were not primarily highly-experienced minimally invasive surgery programs. They wanted to determine whether LGB versus OGB had comparable beneficial results in the general US population. The data collected was obtained from the nationwide inpatient sample (NIS is the largest source of all payer discharge information in the United States, which includes roughly a 20% stratified sample of US community hospitals).

In their analysis, Ricciardi et al found that similar to many studies previously published (again their rightful contention is that these studies came from highly specialized centers), the outcomes of LGB were superior to that of OGB. Their patient sample included 26,940 patients in a 2-year period (2001-2002) who underwent either LGB or OGB. Consistent across their data set was a demographic majority of female patients (83%). Of all the patients identified 16.3% had a LGB.

The striking points of their study showed significant reduction in several outcomes in the LGB group versus OGB. Mortality for LGB versus OGB was 0.27% and 0.81%, respectively (P < 0.0001). Additionally, pulmonary complications, cardiovascular complications, and length of stay were also significantly improved in the LGB group.

Commentary

The importance of this study is in its design. Ricciardi et al have reproduced and analyzed data that has implications to the general population. Most of the reports to date have been from large specialty referral centers (LSRC). However, with the increasing number of LGB procedures being performed across the country and expanding to hospitals outside of the LSRC, it is important to identify the impact LGB has on patient outcomes. It is also important to highlight that LGB should be performed by a surgeon with advanced laparoscopic skills and training in bariatric surgery. Surgical societies and insurance companies have now adopted centers of excellence for bariatric surgery for both improved outcomes and as a means for reimbursement for the procedure. The outcomes of the LGB continue to be a driving force in this regard. Data from studies such as this will continue to support the importance of LGB as a superior surgical technique for morbid obesity.