Short-term morbidity and mortality after open versus laparoscopic gastric bypass surgery. A population-based study from Sweden.
BACKGROUND
The number of anti-obesity procedures performed continues to increase and most are now performed laparoscopically. Few population-based studies have examined outcomes after open and laparoscopic anti-obesity surgery.


METHODS
All-cause mortality and cause-specific morbidity was studied in patients who underwent laparoscopic or open gastric bypass (GBP) surgery in all public Swedish hospitals between 1997 and 2006.


RESULTS
Four thousand seven hundred one (3,852 primary) GBP procedures were performed during the study period. Of these, 1,661 were performed laparoscopically and 3,040 by open access. There was no difference in 30-, 90-, or 365-day mortality between open and laparoscopic access. Complications were more common after conversion from previous anti-obesity surgery to GBP (OR 1.9; 95% CI 1.5-2.4; 30-day readmission). Surgical re-intervention due to anastomotic leak or deep infection was higher in laparoscopic GBP compared to open GBP (OR 2.1; 1.3-3.6). Subgroup analysis showed higher leak rates with revisional laparoscopic procedures (conversion to GBP from previous anti-obesity surgery) compared to revisional open (OR 4.1; 1.5-11.2) whereas after primary GBP no statistically significant difference was seen between laparoscopic and open approach (OR 1.7; 1.0-3.1) (p = 0.07).


CONCLUSIONS
Laparoscopic GBP is as safe as open surgery in terms of mortality. Care needs to be taken when converting previous anti-obesity surgery to GBP.
Marsk
Richard
R
Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 182 88 Stockholm, Sweden. Richard.Marsk@ds.se
Tynelius
Per
P
Rasmussen
Finn
F
Freedman
Jacob
J
D000328:Adult; D015331:Cohort Studies; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009767:Obesity, Morbid / Q000401:mortality* / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery; D012086:Reoperation / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013548:Sweden; D016896:Treatment Outcome