Gastric Bypass Surgery: Laparoscopic or Open Procedure

Author: Vickie Richter

If you are one of the millions of people in the United States living with morbid obesity, one of the options to consider is bariatric surgery, often referred to as weight loss surgery. In the last 6 years more than 800,000 people who have had no long-term weight loss success through other means, have chosen this procedure to transform their lives.

Gastric bypass first came to light in the 1960s when patients who had undergone partial stomach removal for ulcer repair also began to observe weight loss. Over the decades, bypass surgery has seen modifications, but is currently performed either by laparoscopic gastric bypass (LGB) or by open gastric bypass (OGB). With bariatric surgery growing in popularity, Dr. Wendy E. Weller, from the University at Albany in New York, and Dr. Carl Rosati, from Albany Medical Center, co-authored a new study to compare outcomes of OGB versus LGB surgery.

The laparoscopic method is preformed by placing several small incisions in the abdomen, allowing very small instruments to be inserted to perform the bypass surgery—as the medical staff views surgical maneuvers on a screen—while the invasive "open" method involves making a large open incision to view and perform the procedure.

The current study, appearing in the Annals of Surgery, reported that the laparoscopic method reduces postoperative complications, the need for a second operation, and shortened hospital stays, although the total cost of the procedure for LGB averaged $30,033 vs. $28,107 for OGB.

Using the Nationwide Inpatient Sample, the study found that of the 19,156 subjects who received bypass surgery in 2005; almost 75 percent were preformed by the laparoscopic method, with greatly reduced risk of complications. With open surgery, the risk of pulmonary complications increased by 92 percent, cardiovascular complications increased to 54 percent, the risk for sepsis, a serious system-wide infection, more than doubled and the risk of anastomotic leak, leakage from the operative site, was 32 percent higher. The average hospital stay was reduced by about 1 day with LGB method opposed to the open surgery technique.

By reducing the size of the surgical incision and the trauma associated with the operative exposure, a summary of advantages of laparoscopic verses open gastric bypass surgery are:

• Lesser intraoperative blood loss
• Shorter hospitalization
• Reduced postoperative pain
• Less pulmonary complications
• Faster recovery
• Better cosmesis
• Fewer wound complications (hernias and infections)

While these findings suggest some advantages with the laparoscopic operation, "most reassuring for the bariatric surgery community is that the hospital outcomes were excellent overall in both the laparoscopic and open procedures," said Dr. Michael G. Sarr, from the Mayo Clinic in Rochester, Minnesota.