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Open Roux-en-Y gastric bypass associated with higher 30-day mortality, more complications than laparoscopic approach, study shows

Friday, December 12 2008 | Comments

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What's This? Open Roux-en-Y gastric bypass (ORYGB) confers a higher risk of mortality within 30 days and higher risk of major complications than laparoscopic Roux-en-Y gastric bypass (LRYGB), new research shows.

During a 2-year period (2005-2006), researchers conducted 2 analyses and measured patient outcomes using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant Use File. In the first analysis, 30-day morbidity and mortality outcomes were compared between patients who underwent LRYGB (n=4,631) or ORYGB (n=1,146). In the second analysis, they compared these outcomes in patients who underwent LRYGB (n=3,580) or laparoscopic adjustable gastric banding (LAGB; n=1,176).

For the NSQIP, preoperative variables were collected, including the patient's demographics and their comorbidities/risk factors for undergoing surgery. Outcome variables, such as postoperative mortality, hospital length of stay, need for reoperation, and 19 different surgical complications, were also assessed.

Compared with patients who underwent LRYGB, those who underwent ORYGB had a higher 30-day incidence of mortality (0.79% vs 0.17%; P=.002), major complication rate (7.42% vs 3.37%; P<.0001), and any complication rate (13.18% vs 6.69%; P<.0001). Subjects who underwent ORYGB also had more return visits to the OR (4.97% vs 3.56%; P=.032) and longer hospital stay after surgery (median, 3 days vs 2 days; P<.0001).

In a risk-adjusted model, the odds of major complication after ORYGB were still higher as compared with LRYGB (odds ratio [OR], 2.04; 95% CI, 1.54-2.69; P<.001).

In the separate analysis that compared outcomes between LRYGB and LAGB, the investigators found a similar rate of 30-day mortality (0.09% for LABG vs 0.14% for LRYGB; P=1.0). However, patients who underwent LAGB had a lower rate of major complications (1.0% vs 3.3%; P<.0001), any complication (2.6% vs 6.7%; P<.0001), and return visits to the OR (0.94% vs 3.6%; P<.0001) as well as a shorter postoperative hospital stay (median, 1 day vs 2 days; P<.0001). In the risk-adjusted model, LAGB was associated with lower odds of a major complication (OR, 0.29; 95% CI, 0.16-0.53; P<.001).

"While ORYGB may sometimes be indicated, a laparoscopic approach may be safer for RYGB when feasible," the authors said. "LAGB, compared with LRYGB, has a similarly low mortality rate and a small but statistically significant decrease in risk-adjusted 30-day complications. Clinical efficacy and long-term outcomes will need to be evaluated to determine superiority between these procedures." (Lancaster RT and Hutter MM. Surg Endosc 2008;22:2554-2563.)

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