A large retrospective study from Stanford University Medical Center confirms and supports the advantages of using laparoscopic surgical techniques rather than open surgery for Roux-en-Y gastric bypass procedures.
After comparing differences in outcomes of more than 150,000 gastric bypass patients, the researchers found that the laparoscopic approach resulted in significantly fewer complications, a shorter hospital stay, lower total costs, and less risk of death, even after adjusting for patient co-morbidities (other health conditions) and socioeconomic levels.
To perform this study, researchers gathered data on the Roux-en-Y gastric bypass surgeries performed from 2005 to 2007 in the United States from the Nationwide Inpatient Sample (NIS), a hospital discharge database created as part of the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project. The NIS is the largest publicly available, all-payer, inpatient database in the United States.
The data included a total of 156,271 gastric bypass surgeries – 41,094 open procedures and 115,177 laparoscopic procedures. Demographic information showed that most patients were white (75%) and female (82.5%) with a median age of 42.7.
Laparoscopic procedures were more common in high-volume hospitals (69% vs 61%) and with private insurance (75.1% and 69.9%), while a higher percentage of open procedures involved either Medicare (9.3% vs 7.1%) or Medicaid (10.4% vs 5.9%) beneficiaries.
A greater proportion of patients with open surgery had diabetes (31.4% vs 29.6%) and obstructive sleep apnea (28.6% vs 26.2%), while a greater proportion of patients with laparoscopic surgery had venous stasis (1.3% vs 0.7%). There was no significant differences with hypertension between the two groups of patients.
The findings for in-hospital outcomes showed the following advantages for laparoscopic surgery:
- Shorter length of hospital stay (2.4 days, vs 3.5 days for open)
- Lower total hospital charges ($32,671, vs $35,018 for open)
- Fewer complications (12.3%, vs 18.7% for open)
- Lower mortality (0.1%, vs 0.2% for open)
- Lower rate of nonroutine disposition (2.4%, vs 7.7% for open)
Researchers noted study limitations included the use of administratively collected data which omitted clinical information such as body mass index and does not include information on complications after hospitalization.
Nevertheless, researchers concluded that laparoscopic Roux-en-Y gastric bypass surgery provided greater patient safety and lower resource use than open Roux-en-Y gastric bypass surgery.
Gastric Bypass Surgery
Gastric bypass surgery is a type of weight loss surgery that involves sectioning off the upper part of the stomach to form a new, smaller pouch and connecting it to the middle portion of the small intestine. It promotes weight loss through food restriction and nutrient malabsorption.
The gastric bypass procedure has been performed via open surgery since 1967 and laparoscopically since 1993 following the development of laparoscopic technology. The open surgical approach requires one large incision in the abdomen, while the laparoscopic method uses several smaller incisions for access into the abdominal cavity with specialized surgical tools and camera.
Laparoscopic surgery has many advantages, but it is complex and requires lengthy specialty training and hundreds of cases for a surgeon to develop expertise. Many surgeons cannot perform laparoscopic procedures safely and among those who are skilled in the advanced techniques, most were never trained in bariatric surgery.
When choosing a surgeon to perform gastric bypass surgery, patients should evaluate the training and experience of the surgeon in both the gastric bypass procedure and laparoscopic techniques as it can have a direct impact on the surgical outcome.
Source: “Laparoscopic vs Open Gastric Bypass Surgery:Differences in Patient Demographics, Safety, and Outcomes,” Gaurav Banka, MD; Gavitt Woodard, MD; Tina Hernandez-Boussard, PhD, MPH; John M. Morton, MD, MPH; Arch Surg. 2012.