title: Comparing outcomes of hand-assisted versus total laparoscopic gastric bypass.
abstract: BACKGROUND
  Previous studies have compared open versus hand-assisted and open versus total laparoscopic Roux-en-Y gastric bypass. This study compared hand-assisted and total laparoscopic Roux-en-Y gastric bypass surgery performed at 2 institutions by 2 surgeons, each specializing in 1 of the techniques.
  
  
  METHODS
  Gastric bypass operations (n = 272) were evaluated from January 1, 2004 to December 31, 2004. The comparisons between the hand-assisted (n = 149) and laparoscopic (n = 123) approach were done using the median test, t test, chi-square analysis, and Fisher's exact test.
  
  
  RESULTS
  The average patient age was 43.9 years, and 84% (229 of 272) of the patients were women. The average body mass index was 48.8 kg/m2. No significant difference was found between the hand-assist and laparoscopic groups in age, gender, preoperative body mass index, diabetes, hypertension, or operative time. No significant difference was found in the mortality rate between the hand-assist (2 of 149, 1.3%) and laparoscopic (1 of 123, 0.8%) groups. Also, no significant difference was found in the incidence of leaks, pulmonary embolism, deep venous thrombosis, wound infection, bowel obstruction, incisional hernia, fistula, persistent vomiting, or reoperation between the 2 procedures. A significant difference was found in the length of stay, with a median of 3 days for the hand-assist group and 2 days for the laparoscopic group (P <.001), and hemorrhage requiring transfusion, which occurred in 1 (.7%) of 149 hand-assist patients and 7 (5.7%) of 123 laparoscopic patients (P = .025). The percentage of excess weight loss 6 months after surgery was also similar between the two groups, at 50.2% and 52.1% for the hand-assist and laparoscopic groups, respectively (P = .45).
  
  
  CONCLUSIONS
  The results of this study have found that both hand-assist and laparoscopic Roux-en-Y gastric bypass can be accomplished with similar perioperative risks and outcomes, including weight reduction. The choice between the 2 procedures depends on surgeon preference.
authors.affiliation: Department of Surgery, Good Samaritan Hospital, Cincinnati, Ohio, USA.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Hassan
authors.forename: George
authors.initials: G
authors.lastname: Kerlakian
authors.forename: Trace
authors.initials: T
authors.lastname: Curry
authors.forename: Amy
authors.initials: A
authors.lastname: Engel
authors.forename: Cyndy
authors.initials: C
authors.lastname: Bollmer
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y; D016009:Chi-Square Distribution; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications; D016896:Treatment Outcome