Open versus laparoscopic Roux-en-Y gastric bypass: a comparative study of over 25,000 open cases and the major laparoscopic bariatric reported series.
BACKGROUND
Laparoscopic bariatric surgery has experienced a rapid expansion of interest over the past 5 years, with a 470% increase. This rapid expansion has markedly increased overall cost, reducing surgical access. Many surgeons believe that the traditional open approach is a cheaper, safer, equally effective alternative.


METHODS
16 highly experienced "open" bariatric surgeons with a combined total of 25,759 cases representing >200 surgeon years of experience, pooled their open Roux-en-Y gastric bypass (ORYGBP) data, and compared their results to the leading laparoscopic (LRYGBP) papers in the literature.


RESULTS
In the overall series, the incisional hernia rate was 6.4% using the standard midline incision. Utilizing the left subcostal incision (LSI), it was only 0.3%. Return to surgery in <30 days was 0.7%, deaths 0.25%, and leaks 0.4%. Average length of stay was 3.4 days, and return to usual activity 21 days. Small bowel obstruction was significantly higher with the LRYGBP. Surgical equipment costs averaged approximately $3,000 less for "open" cases. LRYGBP had an added expense for longer operative time. This more than made up for the shorter length of stay with the laparoscopic approach.


CONCLUSIONS
The higher cost, higher leak rate, higher rate of small bowel obstruction, and similar long-term weight loss results make the "open" RYGBP our preferred operation. If the incision is taken out of the equation (i.e. use of the LSI), the significant advantages of the open technique become even more obvious.
Jones
Kenneth B
KB
Bariatric Surgery Center of the SE, CHRISTUS Schumpert Health System, Shreveport, LA 71101, USA. pbsurgkj@aol.com
Afram
Joseph D
JD
Benotti
Peter N
PN
Capella
Rafael F
RF
Cooper
C Gary
CG
Flanagan
Latham
L
Hendrick
Steven
S
Howell
L Michael
LM
Jaroch
Mark T
MT
Kole
Kerry
K
Lirio
Oscar C
OC
Sapala
James A
JA
Schuhknecht
Michael P
MP
Shapiro
Robert P
RP
Sweet
William A
WA
Wood
Michael H
MH
D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D046449:Hernia, Abdominal / Q000453:epidemiology; D006801:Humans; D007415:Intestinal Obstruction / Q000453:epidemiology; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D016896:Treatment Outcome