Laparoscopic vs open Roux-en-Y gastric bypass: a prospective, randomized trial

Abstract

Background: The feasibility of laparoscopic Roux-en-Y gastric bypass (Lap-RYGBP) for morbid obesity is well documented. In a prospective randomized trial, we compared laparoscopic and open surgery.

Methods: 51 patients (48 females, mean (+/- SD) age 36 +/- 9 years and BMI 42 +/- 4 kg/m2) were randomly allocated to either laparoscopy (n = 30) or open surgery (n = 21). All patients were followed for a minimum of 1 year.

Results: In the laparoscopy group, 7 patients (23%) were converted to open surgery due to various procedural difficulties. In an analysis, with the converted patients excluded, the morphine doses used postoperatively were significantly (p < 0.005) lower in the laparoscopic group compared to the open group. Likewise, postoperative hospital stay was shorter (4 vs 6 days, p < 0.025). Six patients in the laparoscopy group had to be re-operated due to Roux-limb obstruction in the mesocolic tunnel within 5 weeks. The weight loss expressed in decrease in mean BMI units after 1 year was 14 +/- 3 and 13 +/- 3 after laparoscopy and open surgery, respectively (not significant).

Conclusions: Both laparoscopic and open RYGBP are effective and well received surgical procedures in morbid obesity. Reduced postoperative pain, shorter hospital stay and shorter sick-leave are obvious benefits of laparoscopy but conversions and/or reoperations in 1/4 of the patients indicate that Lap-RYGBP at present must be considered an investigational procedure.