A comparison of open and laparoscopic Roux-en-Y gastric bypass surgery for morbid and super obesity: a decision-analysis model.
BACKGROUND
The aim of this study was to compare laparoscopic Roux-en-Y gastric bypass (LGBP) with open Roux-en-Y gastric bypass (OGBP) to determine which approach resulted in better clinical outcomes and cost effectiveness in patients with morbid obesity.


METHODS
A decision-analysis model was constructed to evaluate outcomes of LGBP versus OGBP in patients with body mass index (BMI) ranges of 35 to 49, 50 to 60, and greater than 60. Baseline assumptions for the model were derived from published reports. Sensitivity and cost-effectiveness analyses were performed to determine the optimal strategy. Success was defined as no major procedure-related complications and no long-term complications over a 1-year period after surgery. Failure of therapy was defined as either recurrent symptoms or death attributed to a surgical complication.


RESULTS
In patients with a BMI of 35 to 49, LGBP failed in 14% and OGBP failed in 18% of patients, favoring LGBP alone as the dominant strategy. Mortality in the OGBP group was 1.3 times that of the LGBP group. For a BMI of 50 to 60, LGBP was dominant with an overall success rate of 82% as compared with OGBP (77%). Mortality in the OGBP group was 1.3 times that of the LGBP group. For a BMI of greater than 60, LGBP was the dominant strategy with an overall success rate of 67% compared with OGBP (63%). Sensitivity and cost-effective analysis showed that LGBP was the dominant strategy in terms of greater success and less overall morbidity and mortality for all 3 groups.


CONCLUSIONS
This analysis suggests that for all BMI ranges evaluated, LGBP is preferable to OGBP. These conclusions are limited by potential selection and publication bias in the trials assessed for this analysis. These limitations can be resolved only by randomized control trials.
Siddiqui
Ali
A
Division of Gastroenterology, VA North Texas Health Care System and University of Texas Southwestern Medical School, Dallas, TX, USA.
Livingston
Edward
E
Huerta
Sergio
S
D015992:Body Mass Index; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D015390:Gastric Bypass / Q000191:economics / Q000379:methods* / Q000401:mortality; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D009767:Obesity, Morbid / Q000191:economics / Q000401:mortality / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D013781:Texas