Roux-en-Y gastric bypass has lower costs and complications in bariatric surgery.

“Laparoscopic bariatric surgery has experienced a rapid expansion of interest over the past 5 years, with a 470% increase. This rapid expansion has markedly increased overall cost, reducing surgical access. Many surgeons believe that the traditional open approach is a cheaper, safer, equally effective alternative,” scientists in the United States report.

K.B. Jones and colleagues working with the Bariatric Surgery Center in Shreveport explained, “16 highly experienced ‘open’ bariatric surgeons with a combined total of 25,759 cases representing >200 surgeon years of experience, pooled their open Roux-en-Y gastric bypass (ORYGBP) data, and compared their results to the leading laparoscopic (LRYGBP) papers in the literature.”

They found, “In the overall series, the incisional hernia rate was 6.4% using the standard midline incision. Utilizing the left subcostal incision (LSI), it was only 0.3%. Return to surgery in <30 days was 0.7%, deaths 0.25%, and leaks 0.4%. Average length of stay was 3.4 days, and return to usual activity 21 days. Small bowel obstruction was significantly higher with the LRYGBP. Surgical equipment costs averaged similar to$3,000 less for ‘open’ cases.

LRYGBP had an added expense for longer operative time. This more than made up for the shorter length of stay with the laparoscopic approach.”

Investigators concluded, “The higher cost, higher leak rate, higher rate of small bowel obstruction, and similar long-term weight loss results make the ‘open’ RYGBP our preferred operation. It the incision is taken out of the equation (i.e. use of the LSI), the significant advantages of the open technique become even more obvious.”

Jones and colleagues published their study in Obesity Surgery (Open versus laparoscopic Roux-en-Y gastric bypass: A comparative study of over 25,000 open cases and the major laparoscopic bariatric reported series. Obes Surg, 2006;16(6):721-727).

For additional information, contact K.B. Jones, 1801 Fairfield Avenue, Suite 408, Shreveport, LA 71101, USA.

The publisher’s contact information for the journal Obesity Surgery is: F DCommunications Inc., 3100 Bayview Avenue, Unit 4, Toronto, Ontario M2N 5L3, Canada.