Comparing the outcomes after laparoscopic versus open gastric bypass: a matched paired analysis.
BACKGROUND
Laparoscopic gastric bypass (LGBP) is being performed widely as a treatment of choice for morbid obesity. Advantages over open gastric bypass (OGBP) have not been well documented in controlled studies. The aim of this study is to evaluate the early postoperative outcomes after LGBP and OGBP using a matched paired analysis.


METHODS
80 consecutive LGBP patients were matched by age, gender, preoperative BMI, and number of co-morbid medical conditions to 80 OGBP patients. Outcomes included length of stay (LOS), complications, percent excess weight lost (%EWL) and change in BMI over 1 year, time to return to normal activities, and quality of life (QOL). Continuous variables were analyzed using Wilcoxon Signed Ranks and discrete data were analyzed with McNemar tests.


RESULTS
Baseline variables were matched (LGBP/OGBP); age 43/42, mean preoperative BMI 44/46, co-morbid conditions 2.5/2.8. LOS was significantly shorter in the LGBP vs. OGBP group (3.6 vs. 4.3 days). There was a trend to more major complications (internal hernias requiring reoperation) in the LGBP group that did not reach significance. Minor complications were comparable. %EWL was significantly better in the LGBP group at 3, 6, and 9 months, but was comparable to the OGBP group at 1 year (LGBP/OGBP, 69%/65%). BMI at 1 year was also similar (29 vs. 31). LGBP patients returned to normal activities sooner and had equivalent QOL outcomes.


CONCLUSIONS
LGBP provides certain advantages over OGBB. LOS and time to return to normal activities are shorter and early weight loss results may be superior.
Courcoulas
Anita
A
Department of Thoracic and Foregut Surgery, University of Pittsburgh School of Medicine, PA, USA. courcoulasap@msx.upmc.edu
Perry
Yaron
Y
Buenaventura
Percival
P
Luketich
James
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D010149:Postoperative Pain / Q000503:physiopathology; D011183:Postoperative Complications; D011336:Probability; D011379:Prognosis; D011788:Quality of Life; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014481:United States; D015431:Weight Loss