+ Site Statistics
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Hand-assisted laparoscopic gastric bypass does not improve outcome and increases costs when compared to open gastric bypass for the surgical treatment of obesity

Hand-assisted laparoscopic gastric bypass does not improve outcome and increases costs when compared to open gastric bypass for the surgical treatment of obesity

Surgical Endoscopy 16(10): 1452-1455

Hand-assisted laparoscopic Roux-en-Y gastric bypass (Hand-Lap GB) has been adopted by some surgeons to treat morbid obesity because it is easier to perform than the total laparoscopic procedure, but to date no study has compared the outcomes of patients undergoing the Hand-Lap GB to those obtained with the open procedure (Open GB). We hypothesized that patients undergoing Hand-Lap GB would lose a similar amount of weight when compared to Open GB patients, while experiencing no increase in complications, a shorter hospital stay, and lower overall costs of care, in part as a result of fewer incisional hernias requiring subsequent surgery. Nonrandomized, prospective data were collected on all patients undergoing proximal GB via Hand-Lap or open approaches between May 1998 and July 1999. Our first 25 Hand-Lap GB procedures, performed in selected patients (with no extensive previous abdominal surgery) referred to two of us (E.J.D, M.A.S), were compared to all other (n = 62) concurrent open proximal GB performed by the group during this period of time in patients with body mass index (BMI) <50 kg/m2. Preoperatively, Hand-Lap GB patients did not differ from Open GB patients in age (40 +/- 11 vs 43 +/- 11 years), gender (92% female vs 81% female), incidence or type of preoperative comorbid conditions, preoperative weight (282 +/- 33 vs 280 +/- 37 lb), or BMI (45.5 +/- 5.4 vs 44.1 +/- 3.3 kg/m2). (Data given as mean +/- standard deviation). Although length of hospital stay did not differ between groups (3.6 +/- 1.3 vs 4.2 +/- 4.6 days), total hospital costs were significantly higher for Hand-Lap GB ($14,725 +/- 3089 vs. $10,281 +/- 3687, p <0.01 ANOVA). One patient in the Open GB group developed an anastomotic leak from the gastrojejunostomy. Follow-up revealed that Hand-Lap GB patients had a similar risk of postoperative complications as the Open GB group, including marginal ulcer (16% vs 14.5%), stomal stenosis (24% vs 23%), and, most notably, incisional hernia (20% vs 27%). There were no major wound infections or deaths in either group. One patient in each group developed a postoperative small bowel obstruction. Loss of excess weight in Hand-Lap GB patients at 12 months postoperatively was 66 +/- 14% vs 77 +/- 14% in the Open GB group. The Hand-Lap GB yielded good weight reduction in a population of morbidly obese patients, but at a higher cost for hospital care than Open GB. There was no decrease in the incidence of incisional hernias with the Hand-Lap GB procedure. Although Hand-Lap GB appears to be safe and effective, its failure to provide a decrease in hospital stay or risk of incisional hernia requiring subsequent surgical repair is significant. The primary role for the Hand-Lap GB procedure should therefore be to aid surgeons in developing skills to climb the steep learning curve for total laparoscopic gastric bypass, since Hand-Lap GB does not improve patient outcome and increases cost in comparison to the open GB procedure.

(PDF emailed within 0-6 h: $19.90)

Accession: 046211040

Download citation: RISBibTeXText

PMID: 12063573

DOI: 10.1007/s00464-001-8321-5

Related references

Randomized clinical trial of hand-assisted laparoscopic versus open Roux-en-Y gastric bypass for the treatment of morbid obesity. British Journal of Surgery 91(4): 418-423, 2004

Laparoscopic gastric bypass has shorter length of stay and less narcotic usage compared with open gastric bypass. Gastroenterology 118(4 Suppl 2 Part 2): SSAT A1511, 2000

Laparoscopic Roux-en-Y gastric bypass versus laparoscopic mini gastric bypass in the treatment of obesity: study protocol for a randomized controlled trial. Trials 18(1): 226, 2018

A prospective randomized trial of laparoscopic gastric bypass versus laparoscopic adjustable gastric banding for the treatment of morbid obesity: outcomes, quality of life, and costs. Annals of Surgery 250(4): 631-641, 2011

A comparison of hand-assisted, laparoscopic and open Roux-en-Y gastric bypass surgery. Gastroenterology 118(4 Suppl 2 Part 1): SSAT A1052, 2000

An institutional experience with laparoscopic gastric bypass complications seen in the first year compared with open gastric bypass complications during the same period. American Journal of Surgery 183(5): 533-538, 2002

Outcome of hand-assisted laparoscopic gastric bypass in super obese patients. Surgery for Obesity and Related Diseases 4(5): 618-624, 2008

Preliminary outcomes of laparoscopic adjustable gastric banding and Roux-en-Y gastric bypass in surgical obesity treatment. Polski Merkuriusz Lekarski 23(137): 344-347, 2008

Hand-assisted laparoscopic Roux-en-y gastric bypass: aspects of surgical technique and early results. Obesity Surgery 10(5): 420-427, 2000

Short-term outcome of laparoscopic gastric bypass and minigastric bypass on obesity patients with type 2 diabetes mellitus. Zhonghua Wei Chang Wai Ke Za Zhi 12(6): 554-557, 2010

Laparoscopic Roux-en-Y gastric bypass in adolescents with morbid obesity--surgical aspects and clinical outcome. Seminars in Pediatric Surgery 23(1): 11-16, 2014

The safety of laparoscopic hand-sutured gastrojejunostomy in gastric bypass for the treatment of morbid obesity. Obesity Surgery 23(9): 1487-1492, 2014

Laparoscopic Roux-en-Y gastric bypass (LRYGB) after Loop gastric bypass and gastro-gastric fistula and reversed jejunoileal bypass. Surgery for Obesity and Related Diseases 12(7): S34-S35, 2016

Laparoscopic conversion of One Anastomosis Gastric Bypass/Mini Gastric Bypass to Roux en Y gastric bypass for Bile Reflux Gastritis. Surgery for Obesity and Related Diseases 12(7): S164-S165, 2016

Laparoscopic conversion of one anastomosis gastric bypass/mini gastric bypass to Roux-en-Y gastric bypass for bile reflux gastritis. Surgery for Obesity and Related Diseases 13(1): 119-121, 2016