Overview of outcomes of laparoscopic and open Roux-en-Y gastric bypass in the United States

Abstract

Introduction: Roux-en-Y Gastric Bypass is the gold standard procedure for weight loss surgery and is the most commonly performed bariatric operation in the United States. Laparoscopic gastric bypass (LGBP) has become the predominantly used technique for weight loss surgery since 2004. The aim of this study was to compare surgical outcomes of LGBP versus open gastric bypass (OGBP) for the treatment of morbid obesity.

Methods: Using the Nationwide Inpatient Sample database, clinical data of morbidly obese patients who underwent LGBP or OGBP from 2006 to 2008 were analyzed. Outcome measures included patient characteristics, comorbidities, postoperative complications, length of hospital stay (LOS), hospital charges, and in-hospital mortality.

Results: A total of 226,043 morbidly obese patients underwent gastric bypass during the three-year period (LGBP: 183,452 [81.16%], OGBP: 42,591[18.84%]). The majority of patients in both groups were female (LGBP: 81.0% vs. OGBP: 78.5%, p < 0.01) and Caucasian (LGBP: 73.9% vs. OGBP: 72.6%, p < 0.01). Most comorbidities were significantly higher in the OGBP group. All specific postoperative complications were significantly higher in the OGBP group (urinary tract infection [UTI], pneumonia, acute renal failure, respiratory failure, myocardial infarction, venous thromboembolism, ileus, gastrointestinal leak, wound infection, and bowel obstruction). LGBP was associated with lower overall postoperative complications (3.5% vs. 10.8%; p < 0.01), shorter LOS (2.4 days vs. 4.2 days; p < 0.01), lower mortality (0.06 vs. 0.52; p < 0.01), and lower hospital costs ($39,570 vs. $45,629; p < 0.01) compared with the OGBP.

Conclusion: LGBP was associated with shorter LOS, lower morbidity, lower mortality, and lower hospital costs compared with those of OGBP. The laparoscopic approach to gastric bypass should be considered the gold standard approach for the treatment of morbid obesity.