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Study shows less invasive weight loss surgery is safer, cheaper and requires shorter hospital stay

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Gastric bypass surgery, a popular surgical alternative for weight loss in obese patients, is safer when performed using minimally invasive laparoscopic techniques rather than open surgery requiring a large incision, according to a new study.

Researchers from Stanford University Medical School compared how patients fared after having gastric bypass surgery either by open surgery or by the less invasive laparoscopic surgery and found that laparoscopic patients suffered fewer complications, as well as having lower mortality rates, shorter hospital stays afterward and smaller medical bills.

In the digestive tract, food travels from the stomach into the small intestine, where absorption of most of the food’s calories and nutrients takes place, before moving into the large intestine. Gastric bypass is a surgical procedure in which a portion of the stomach becomes a smaller stomach pouch that restricts the amount of food a patient can eat at one time. Surgeons then attach this smaller stomach pouch to the middle of the small intestine, thereby bypassing much of the small intestine to reduce calorie and nutrient absorption.

Gastric bypass surgery carries serious risks of complications such as heart attack, stroke, infection, blood loss, blood clots, lung and breathing problems, perforation or leaks from the gastrointestinal system into abdominal cavity, gallstones, osteoporosis, anemia and death.

Study researchers analyzed data from the 2005-2007 Nationwide Inpatient Sample (NIS), a hospital discharge database created as part of the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project, for 41,094 patients who underwent an open Roux-en-Y gastric bypass (ORYGB) procedure and 115,177 patients who had the minimally invasive laparoscopic Roux-en-Y gastric bypass (LRYGB).

“The patients who underwent the laparoscopic, or minimally invasive, procedure had lower mortality rates, lower complication rates, shorter hospital stays and lower hospital charges compared with those who underwent open surgery, even after adjusting for differences in the patients’ socioeconomic levels and co-morbidities,” said a Stanford School of Medicine news release.

Just 12% of laparoscopic gastric bypass patients experienced complications compared to 19% of open gastric bypass patients. Laparoscopic patients experienced lower rates of in-hospital complications across 18 complication categories, including cardiac arrhythmia, sepsis and the need for a blood transfusion.

The study also showed that Medicare and Medicaid patients were more likely to have the open gastric bypass procedure.

"For patients considering weight loss surgery, especially gastric bypass, they should have a very thorough conversation with their surgeon about the planned approach, and a laparoscopic approach should be the preferred approach if possible," Dr. Anita Courcoulas, a University of Pittsburgh Medical Center professor and bariatric surgeon who was not part of the study, told Reuters.

Laparoscopic vs Open Gastric Bypass Surgery : Differences in Patient Demographics, Safety, and Outcomes appears in the June 2012 issue of Archives of Surgery.

“To our knowledge, this is the first national, all-payer, all-hospital, and largest comparison of LRYBG and ORYGB,” said the study.

“There have been single-center randomized trials that support the greater safety and efficacy of the minimally invasive approach, but what our study does is to confirm that those results are actually occurring in practice at hospitals and academic medical centers across the country,” said senior study author John Morton, MD, MPH, associate professor of surgery at the Stanford School of Medicine.

The Stanford Center for Outcomes Research and Evaluation, Stanford University Medical School and Stanford University Hospitals and Clinics funded the study.