Gastric Bypass - Laparoscopy Versus Open Approach: Do We Now Have an Answer?

Three-Year Follow-up of a Prospective Randomized Trial Comparing Laparoscopic Versus Open Gastric Bypass.

Summary
"How does laparoscopic surgery for morbid obesity compare with open gastric bypass? The authors conducted a randomized trial involving 155 patients who were followed for a mean period of 39 months. The same Roux-en-Y gastric bypass procedure was employed for both groups. Weight loss, reduction in comorbidities, and improvement in the quality of life were similar between the 2 groups. The major difference was in the frequency of incisional hernias, which was 39 per cent in the open group, compared with only 5 per cent in the laparoscopic group. (P < .01.)"

Viewpoint
"On the basis of this report and a previous short-term follow-up study on the same patients,[1] the authors point out that the results of surgery for morbid obesity are similar after either open or laparoscopic surgery. The short-term advantages of laparoscopic surgery pertain to shorter hospitalization and faster recovery; the main long-term advantage is a significant reduction in the frequency of incisional hernias - a serious complication. The authors believe that laparoscopic gastric bypass should become the procedure of choice for patients with morbid obesity."

References:
[1] Nguyen NT, Goldman C., Rosenquist CJ et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;234:279-289.

Source:
Puzziferri N, Austrheim-Smith IT, Wolfe BM, et al, in: Ann Surg. 2006;243:181-188

Albert B. Lowenfels, MD, Medscape General Surgery. 2006;8(1) ©2006 Medscape

Albert B. Lowenfels, MD, Professor of Surgery, Department of Surgery, New York Medical College, Valhalla, New York; Staff Physician, Westchester Medical Center, Valhalla, New York.

Disclosure: "Albert B. Lowenfels, MD, has disclosed no relevant financial relationships."