Is laparoscopic gastric bypass surgery the way to go?

Robin Wulffson MD's picture
gastric bypass, laparoscopic surgery, robotic-assisted, complications
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Gastric bypass surgery is an option for morbidly obese patients who are unsuccessful in losing weight with diet and exercise programs. It results in dramatic weight loss and overall health improvement by resolving diseases such as hypertension and type 2 diabetes. As in any major surgical procedures, sever complications, including death can occur. Currently laparoscopic, or minimally invasive surgery, is rapidly gaining in popularity for a wide range of procedures, including heart surgery, prostate surgery, and gastric bypass surgery. Researchers affiliated with the Stanford University School of Medicine (Stanford, California) conducted a study comparing laparoscopic gastric bypass surgery to the traditional open procedure. They published their findings in June issue of the Archives of Surgery.

The researchers set out to determine national outcome differences between laparoscopic Roux-en-Y gastric bypass (LRYGB) and open Roux-en-Y gastric bypass (ORYGB). The study group was comprised of 115,177 patients who underwent the laparoscopic procedure and 41,094 open procedures. The main outcome measures were the number of procedures performed, patient and hospital characteristics, patient complications, mortality, length of stay, resource use, and Agency for Healthcare Research and Quality Patient Safety Indicators.

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The researchers found that from 2005 to 2007, LRYGB was more commonly performed than ORYGB (laparoscopic: 72%; open: 28%) and at high-volume hospitals. Compared to LRYGB, more ORYGB experienced adverse incidents (open: 7.7%; laparoscopic: 2.4%). The mortality rate was higher for the open procedure (open: 0.2%; laparoscopic: 0.1%). More patients who underwent the open procedure suffered one or more complication (open: 18.7%; laparoscopic: 12.3%). All Patient Safety Indicator rates were higher for ORYGB. Patients who had ORYGB compared with LRYGB also had longer average lengths of hospital stay (open: 3.5 days; laparoscopic: 2.4 days) and higher total charges (open: $35,018; laparoscopic; $32,671). Even after adjusting for confounding variables (variables that can impact the validity of the data). Patients who underwent LRYGB had a lower odds ratio than patients who had ORYGB for both mortality and having one or more complications.

The authors concluded that in their study, LRYGB provided greater safety than ORYGB even after adjusting for patient-level socioeconomic and comorbidity differences.

Take home message:
Although most patients who underwent either type of procedure did well in the short-term, the procedure is associated with long-term complications, including death. Thus, it is far preferable to lose excess pounds by non-surgical methods. Some patients who undergo the procedure are not morbidly obese; however, they are still subject to complications. Although patients can be insistent on undergoing the procedure, a responsible surgeon has the right to say no. This study pointed out the advantages of laparoscopic surgery; however, the choice of the surgeon and medical center are factors that influence the chance of a good outcome. Facilities such as Stanford University Medical Center provide state-of-the-art care. A recent trend in laparoscopic surgery is robotically-assisted procedures. This provides 3D, magnified visualization of internal structures as well as precise instrument manipulation. It is also best to seek out a surgeon who has performed at least 50 procedures, even if it means traveling a distance to a medical center with an excellent reputation.

Reference
: Archives of Surgery

See also: New study reports robotic surgery safer but costlier

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