Laparoscopic versus open gastric bypass: A randomized study of outcomes, quality of life, and costs

Ninh T. Nguyen, Charles Goldman, C. John Rosenquist, Andres Arango, Carol J. Cole, Steven J. Lee, Bruce Wolfe

Research output: Contribution to journalArticle

811 Citations (Scopus)

Abstract

Objective: To compare outcomes, quality of life (QOL), and costs of laparoscopic and open gastric bypass (GBP). Summary Background Data: Laparoscopic GBP has been reported to be a safe and effective approach for the treatment of morbid obesity. The authors performed a prospective randomized trial to compare outcomes, QOL, and costs of laparoscopic GBP with those of open GBP. Methods: From May 1999 to March 2001, 155 patients with a body mass index (BMI) of 40 to 60 kg/m2 were randomly assigned to undergo laparoscopic (n = 79) or open (n = 76) GBP. The two groups were similar in age, sex ratio, mean BMI, and comorbidities. Main outcome measures included operative time, estimated blood loss, length of hospital stay, operative complications, percentage of excess body weight loss, and time to return to activities of daily living and work. Changes in QOL were assessed using the SF-36 Health Survey and the bariatric analysis of reporting outcome system (BAROS). Operative and hospital costs of the two operations were also compared. Results: There were no deaths in either group. Mean operative time was longer for laparoscopic GBP than for open GBP, but operative blood loss was less. Two (2.5%) of the 79 patients in the laparoscopic group required conversion to laparotomy. Median length of hospital stay was shorter for laparoscopic GBP patients (3 vs 4 days). The rate of postoperative anastomotic leak was similar between groups. Wound-related complications such as infection (10.5 vs 1.3%) and incisional hernia (7.9 vs 0%) were more common after open GBP; late anastomotic stricture was less frequent after open GBP (2.6 vs 11.4%). Time to return to activities of daily living and work were shorter after laparoscopic GBP than after open GBP. Weight loss at 1 year was similar between groups. Preoperative SF-36 scores were similar between groups; however, at 1 month after surgery, laparoscopic patients had better physical conditioning, social functioning, general health, and less body pain than open GBP patients. At 6 months, the BAROS outcome was classified as good or better in 97% of laparoscopic GBP patients compared with 82% of open GBP patients. Operative costs were higher for laparoscopic GBP patients, but hospital costs were lower. Conclusions: Laparoscopic GBP is a safe and cost-effective alternative to open GBP. Despite a longer operative time, patients undergoing laparoscopic GBP benefited from less blood loss, a shorter hospital stay, and faster convalescence. Laparoscopic GBP patients had comparable weight loss at 1 year but a more rapid improvement in QOL than open GBP patients. The higher initial operative costs for laparoscopic GBP were adequately offset by the lower hospital costs.

Original languageEnglish (US)
Pages (from-to)279-291
Number of pages13
JournalAnnals of Surgery
Volume234
Issue number3
DOIs
StatePublished - 2001
Externally publishedYes

Fingerprint

Gastric Bypass
Quality of Life
Outcome Assessment (Health Care)
Costs and Cost Analysis
Length of Stay
Hospital Costs
Operative Time
Bariatrics
Weight Loss
Activities of Daily Living
Body Mass Index

ASJC Scopus subject areas

  • Surgery

Cite this

Laparoscopic versus open gastric bypass : A randomized study of outcomes, quality of life, and costs. / Nguyen, Ninh T.; Goldman, Charles; Rosenquist, C. John; Arango, Andres; Cole, Carol J.; Lee, Steven J.; Wolfe, Bruce.

In: Annals of Surgery, Vol. 234, No. 3, 2001, p. 279-291.

Research output: Contribution to journalArticle

Nguyen, Ninh T. ; Goldman, Charles ; Rosenquist, C. John ; Arango, Andres ; Cole, Carol J. ; Lee, Steven J. ; Wolfe, Bruce. / Laparoscopic versus open gastric bypass : A randomized study of outcomes, quality of life, and costs. In: Annals of Surgery. 2001 ; Vol. 234, No. 3. pp. 279-291.
@article{740cc5f40c754a37b0bcda664af6b245,
title = "Laparoscopic versus open gastric bypass: A randomized study of outcomes, quality of life, and costs",
abstract = "Objective: To compare outcomes, quality of life (QOL), and costs of laparoscopic and open gastric bypass (GBP). Summary Background Data: Laparoscopic GBP has been reported to be a safe and effective approach for the treatment of morbid obesity. The authors performed a prospective randomized trial to compare outcomes, QOL, and costs of laparoscopic GBP with those of open GBP. Methods: From May 1999 to March 2001, 155 patients with a body mass index (BMI) of 40 to 60 kg/m2 were randomly assigned to undergo laparoscopic (n = 79) or open (n = 76) GBP. The two groups were similar in age, sex ratio, mean BMI, and comorbidities. Main outcome measures included operative time, estimated blood loss, length of hospital stay, operative complications, percentage of excess body weight loss, and time to return to activities of daily living and work. Changes in QOL were assessed using the SF-36 Health Survey and the bariatric analysis of reporting outcome system (BAROS). Operative and hospital costs of the two operations were also compared. Results: There were no deaths in either group. Mean operative time was longer for laparoscopic GBP than for open GBP, but operative blood loss was less. Two (2.5{\%}) of the 79 patients in the laparoscopic group required conversion to laparotomy. Median length of hospital stay was shorter for laparoscopic GBP patients (3 vs 4 days). The rate of postoperative anastomotic leak was similar between groups. Wound-related complications such as infection (10.5 vs 1.3{\%}) and incisional hernia (7.9 vs 0{\%}) were more common after open GBP; late anastomotic stricture was less frequent after open GBP (2.6 vs 11.4{\%}). Time to return to activities of daily living and work were shorter after laparoscopic GBP than after open GBP. Weight loss at 1 year was similar between groups. Preoperative SF-36 scores were similar between groups; however, at 1 month after surgery, laparoscopic patients had better physical conditioning, social functioning, general health, and less body pain than open GBP patients. At 6 months, the BAROS outcome was classified as good or better in 97{\%} of laparoscopic GBP patients compared with 82{\%} of open GBP patients. Operative costs were higher for laparoscopic GBP patients, but hospital costs were lower. Conclusions: Laparoscopic GBP is a safe and cost-effective alternative to open GBP. Despite a longer operative time, patients undergoing laparoscopic GBP benefited from less blood loss, a shorter hospital stay, and faster convalescence. Laparoscopic GBP patients had comparable weight loss at 1 year but a more rapid improvement in QOL than open GBP patients. The higher initial operative costs for laparoscopic GBP were adequately offset by the lower hospital costs.",
author = "Nguyen, {Ninh T.} and Charles Goldman and Rosenquist, {C. John} and Andres Arango and Cole, {Carol J.} and Lee, {Steven J.} and Bruce Wolfe",
year = "2001",
doi = "10.1097/00000658-200109000-00002",
language = "English (US)",
volume = "234",
pages = "279--291",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Laparoscopic versus open gastric bypass

T2 - A randomized study of outcomes, quality of life, and costs

AU - Nguyen, Ninh T.

AU - Goldman, Charles

AU - Rosenquist, C. John

AU - Arango, Andres

AU - Cole, Carol J.

AU - Lee, Steven J.

AU - Wolfe, Bruce

PY - 2001

Y1 - 2001

N2 - Objective: To compare outcomes, quality of life (QOL), and costs of laparoscopic and open gastric bypass (GBP). Summary Background Data: Laparoscopic GBP has been reported to be a safe and effective approach for the treatment of morbid obesity. The authors performed a prospective randomized trial to compare outcomes, QOL, and costs of laparoscopic GBP with those of open GBP. Methods: From May 1999 to March 2001, 155 patients with a body mass index (BMI) of 40 to 60 kg/m2 were randomly assigned to undergo laparoscopic (n = 79) or open (n = 76) GBP. The two groups were similar in age, sex ratio, mean BMI, and comorbidities. Main outcome measures included operative time, estimated blood loss, length of hospital stay, operative complications, percentage of excess body weight loss, and time to return to activities of daily living and work. Changes in QOL were assessed using the SF-36 Health Survey and the bariatric analysis of reporting outcome system (BAROS). Operative and hospital costs of the two operations were also compared. Results: There were no deaths in either group. Mean operative time was longer for laparoscopic GBP than for open GBP, but operative blood loss was less. Two (2.5%) of the 79 patients in the laparoscopic group required conversion to laparotomy. Median length of hospital stay was shorter for laparoscopic GBP patients (3 vs 4 days). The rate of postoperative anastomotic leak was similar between groups. Wound-related complications such as infection (10.5 vs 1.3%) and incisional hernia (7.9 vs 0%) were more common after open GBP; late anastomotic stricture was less frequent after open GBP (2.6 vs 11.4%). Time to return to activities of daily living and work were shorter after laparoscopic GBP than after open GBP. Weight loss at 1 year was similar between groups. Preoperative SF-36 scores were similar between groups; however, at 1 month after surgery, laparoscopic patients had better physical conditioning, social functioning, general health, and less body pain than open GBP patients. At 6 months, the BAROS outcome was classified as good or better in 97% of laparoscopic GBP patients compared with 82% of open GBP patients. Operative costs were higher for laparoscopic GBP patients, but hospital costs were lower. Conclusions: Laparoscopic GBP is a safe and cost-effective alternative to open GBP. Despite a longer operative time, patients undergoing laparoscopic GBP benefited from less blood loss, a shorter hospital stay, and faster convalescence. Laparoscopic GBP patients had comparable weight loss at 1 year but a more rapid improvement in QOL than open GBP patients. The higher initial operative costs for laparoscopic GBP were adequately offset by the lower hospital costs.

AB - Objective: To compare outcomes, quality of life (QOL), and costs of laparoscopic and open gastric bypass (GBP). Summary Background Data: Laparoscopic GBP has been reported to be a safe and effective approach for the treatment of morbid obesity. The authors performed a prospective randomized trial to compare outcomes, QOL, and costs of laparoscopic GBP with those of open GBP. Methods: From May 1999 to March 2001, 155 patients with a body mass index (BMI) of 40 to 60 kg/m2 were randomly assigned to undergo laparoscopic (n = 79) or open (n = 76) GBP. The two groups were similar in age, sex ratio, mean BMI, and comorbidities. Main outcome measures included operative time, estimated blood loss, length of hospital stay, operative complications, percentage of excess body weight loss, and time to return to activities of daily living and work. Changes in QOL were assessed using the SF-36 Health Survey and the bariatric analysis of reporting outcome system (BAROS). Operative and hospital costs of the two operations were also compared. Results: There were no deaths in either group. Mean operative time was longer for laparoscopic GBP than for open GBP, but operative blood loss was less. Two (2.5%) of the 79 patients in the laparoscopic group required conversion to laparotomy. Median length of hospital stay was shorter for laparoscopic GBP patients (3 vs 4 days). The rate of postoperative anastomotic leak was similar between groups. Wound-related complications such as infection (10.5 vs 1.3%) and incisional hernia (7.9 vs 0%) were more common after open GBP; late anastomotic stricture was less frequent after open GBP (2.6 vs 11.4%). Time to return to activities of daily living and work were shorter after laparoscopic GBP than after open GBP. Weight loss at 1 year was similar between groups. Preoperative SF-36 scores were similar between groups; however, at 1 month after surgery, laparoscopic patients had better physical conditioning, social functioning, general health, and less body pain than open GBP patients. At 6 months, the BAROS outcome was classified as good or better in 97% of laparoscopic GBP patients compared with 82% of open GBP patients. Operative costs were higher for laparoscopic GBP patients, but hospital costs were lower. Conclusions: Laparoscopic GBP is a safe and cost-effective alternative to open GBP. Despite a longer operative time, patients undergoing laparoscopic GBP benefited from less blood loss, a shorter hospital stay, and faster convalescence. Laparoscopic GBP patients had comparable weight loss at 1 year but a more rapid improvement in QOL than open GBP patients. The higher initial operative costs for laparoscopic GBP were adequately offset by the lower hospital costs.

UR - http://www.scopus.com/inward/record.url?scp=0034849468&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034849468&partnerID=8YFLogxK

U2 - 10.1097/00000658-200109000-00002

DO - 10.1097/00000658-200109000-00002

M3 - Article

C2 - 11524581

AN - SCOPUS:0034849468

VL - 234

SP - 279

EP - 291

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 3

ER -