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

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.

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.

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).

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.