Laparoscopic versus open gastric bypass: A randomized study of outcomes, quality of life, and costs

Objective To compare outcomes, quality of life (QOL), and costs of laparosc opic and open gastric bypass (GBP). Summary Background Data Laparoscopic GBP has been reported to be a safe and effective approach for the treatment of morbid obesity. The authors perfor med a prospective randomized trial to compare outcomes, QOL, and costs of l aparoscopic GBP with those of open GBP. Methods From May 1999 to March 2001, 155 patients with a body mass index (B MI) of 40 to 60 kg/m(2) were randomly assigned to undergo laparoscopic (n = 79) or open (n = 76) GBP. The two groups were similar in age, sex ratio, m ean BMI, and comorbidities. Main outcome measures included operative time, estimated blood loss, length of hospital stay, operative complications, per centage of excess body weight loss, and time to return to activities of dai ly living and work. Changes in QOL were assessed using the SF-36 Health Sur vey and the bariatric analysis of reporting outcome system (BARDS). Operati ve and hospital costs of the two operations were also compared Results There were no deaths in either group. Mean operative time was longe r for laparoscopic GBP than for open GBP, but operative blood loss was less . Two (2.5%) of the 79 patients in the laparoscopic group required conversi on to laparotomy. Median length of hospital stay was shorter for laparoscop ic GBP patients (3 vs 4 days). The rate of postoperative anastomotic leak w as similar between groups. Wound-related complications such as infection (1 0.5 vs 1.3%) and incisional hernia (7.9 vs 0%) were more common after open GBP; late anastomotic stricture was less frequent after open GBP (2.6 vs 11 .4%). Time to return to activities of daily living and work were shorter af ter laparoscopic GBP than after open GBP. Weight loss at 1 year was similar between groups. Preoperative SF-36 scores were similar between groups; how ever, at 1 month after surgery, laparoscopic patients had better physical c onditioning, social functioning, general health, and less body pain than op en GBP patients. At 6 months, the BARDS outcome was classified as good or b etter in 97% of laparoscopic GBP patients compared with 82% of open GBP pat ients. Operative costs were higher for laparoscopic GBP patients, but hospi tal costs were lower. Conclusions Laparoscopic GBP is a safe and cost-effective alternative to op en GBP. Despite a longer operative time, patients undergoing laparoscopic G BP benefited from less blood loss, a shorter hospital stay, and faster conv alescence. Laparoscopic GBP patients had comparable weight loss at 1 year b ut a more rapid improvement in QOL than open GBP patients. The higher initi al operative costs for laparoscopic GBP were adequately offset by the lower hospital costs.