Gastric Bypass Safer with Less Invasive Surgery

Study finds increased risk of death or complications from open gastric bypass surgery vs. the laparoscopic approach.

Obese patients had a significantly higher risk of death and complications with open versus laparoscopic Roux-en-Y gastric bypass surgery (RYGB), a retrospective review of national data showed.

Mortality odds declined by 46 percent and the odds of at least one complication by 34 percent in a comparison of 156,000 patients who underwent RYGB during 2005 to 2007. However, the mortality risk with either open or laparoscopic procedures was low, as reported in the June issue of Archives of Surgery.

“This large, nationally representative comparison confirms and replicates prior randomized trial evidence supporting the laparoscopic approach, indicating safe dissemination of this technology,” John M. Morton, MD, of Stanford University, and coauthors wrote in conclusion. “For bariatric surgery, patient safety may be further enhanced by appropriate application of the laparoscopic approach.”

The efficacy of gastric bypass has made it the dominant approach to surgical treatment of obesity. In 2002, for example, gastric bypass accounted for 88 percent of all bariatric surgery. The introduction of laparoscopic technology led to widespread adoption of minimally invasive gastric bypass, which accounted for 75 percent of gastric bypass procedures by 2005, Morton and co-authors wrote in their introduction.

Multiple single-center trials have compared the safety of open versus laparoscopic RYGB, including two randomized trials that showed better outcomes with laparoscopic surgery.

However, a paucity of comparative evidence has come from population-based studies designed to assess the safety, effectiveness, and adoption of interventions, in part because ICD-9 codes for laparoscopic gastric bypass did not exist until 2004 and were not fully adopted until 2005.

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