Laparoscopic Roux-en-Y gastric bypass for weight loss is being performed with increasing frequency, partly driven by consumer demand.
However, there are no multi-institutional, risk-adjusted, prospective studies comparing laparoscopic and open gastric bypass outcomes.
Dr Matthew Hutter and colleagues compared laparoscopic versus open gastric bypass procedures.
The research team evaluated 30-day morbidity and mortality rates using multi-institutional, prospective, risk-adjusted cohort data.
The team assessed 401 patients undergoing laparoscopic and 955 undergoing open gastric bypass procedures.
The patients were from hospitals involved in the Private Sector Study of the National Surgical Quality Improvement Program.
| Complication rates in the laparoscopic group was 7% vs 15% in the open group|
|Annals of Surgery|
The researchers collected data from 1356 gastric bypass procedures from 2000 to 2003.
The team extensively validated the data points have been extensively validated.
The data points were based on standardized definitions, and were collected by nurse reviewers who are audited for accuracy.
The team found that 30-day mortality rate was about 1% in the open group vs no mortality in the laparoscopic group.
The mortality rate in the open group was non-significant.
The 30-day complication rate was significantly lower in the laparoscopic group as compared with the open group, at 7% vs 15%, respectively.
Multivariate logistic regression analysis was performed to control for potential confounding variables.
The team showed that patients undergoing an open procedure were more likely to develop a complication, vs patients undergoing an laparoscopic procedure.
Propensity score modeling revealed similar results.
The team noted variables that predict higher complication rates after gastric bypass included an open procedure.
A high American Society of Anesthesiologists' class for physical status, functionally dependent patients, and hypertension as a comorbid illness also predict higher complication rates.
Dr Hutter's team concluded, “Multicenter, prospective, risk-adjusted data show that laparoscopic gastric bypass is safer than open gastric bypass, with respect to 30-day complication rate.”