Less-invasive weight loss surgery safer: study

NEW YORK (Reuters Health) - Minimally-invasive weight loss surgery is safer than open surgery, with patients suffering fewer complications during those procedures, according to a new study of more than 150,000 people who had a gastric bypass in the United States.

Patients also left the hospital sooner -- and with a slightly smaller medical bill -- after so-called laparoscopic gastric bypass procedures, researchers from Stanford University in California found.

During gastric bypass, the surgeon creates a pouch out of the top portion of the stomach, then connects it to the small intestine so fewer calories are absorbed during digestion. For laparoscopic procedures, only a few small cuts in the stomach are made and a tiny camera is inserted to allow the surgeon to get a full view during the procedure, as compared to the one large cut made during open surgery.

"From a surgeon's perspective, the ability to see (during) the surgery is enhanced doing it laparoscopically," said Dr. Anita Courcoulas, a professor and bariatric surgeon from the University of Pittsburgh Medical Center, who wasn't part of the new research team.

"From the patient's perspective, there's much less pain, so they can walk and move and return to normal activities sooner."

The findings support past research suggesting the less-invasive procedure is safer, and are "important" because they reflect complications and deaths on a national level, according to Courcoulas.

Dr. John Morton and his colleagues analyzed data on weight loss procedures done at about 1,000 U.S. hospitals each year between 2005 and 2007, including 41,000 open gastric bypass surgeries and 115,000 laparoscopic surgeries.

Looking back at safety records for the procedures, the researchers found about 19 percent of patients undergoing open surgery had at least one complication -- such as developing pneumonia or needing a blood transfusion -- compared to just over 12 percent of those who had less-invasive surgery.

One in 500 obese patients in the open surgery group died during or shortly after the procedure, compared to one in 1,000 in the laparoscopic group.

People getting open surgery also had longer hospital stays -- 3.5 days versus 2.4 days, on average, the researchers reported in the Archives of Surgery. And their procedures cost slightly more, with a price tag of $35,000 compared to just under $33,000.

The records didn't have information on longer-term complications or on how overweight patients were going into the surgery.

WHAT SHOULD PATIENTS BE OFFERED?

Weight loss procedures are typically considered for people with a body mass index of at least 35 and other medical problems such as diabetes, or for people with a BMI of 40 without other related conditions. For a five-foot, six-inch person, that equates to 217 pounds or 248 pounds.

According to data from the American Society for Metabolic and Bariatric Surgery, about 220,000 people had weight loss surgery, including gastric bypass, in 2009.

Courcoulas said for some patients, such as those who've had previous colon and bowel surgeries, open weight loss procedures may be the only option. But that's the exception rather than the rule.

"I think that in most large centers, patients are being offered a laparoscopic procedure exclusively," she told Reuters Health.

"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," Courcoulas concluded.

"The consensus is now overwhelming to suggest a laparoscopic approach first," Morton, the study's senior author, told Reuters Health. He said close to 90 percent of gastric bypass surgery patients are now having their procedures done laparoscopically.

"Pretty much across the board (it has) better outcomes for patients," he added.

In another analysis published in the same journal issue, researchers found six studies of close to 16,000 people having their appendix removed suggested those laparoscopic procedures also came with fewer complications and deaths and shorter hospital stays than open surgeries.

However, Eleanor Southgate of Epsom and St. Helier University Hospitals NHS Trust, Surrey, and her colleagues said there was a lack of information on pain, patient satisfaction and cost of each type of procedure in those studies.

SOURCES: http://bit.ly/M0vcYw and http://bit.ly/MKDMrP Archives of Surgery, online June 18, 2012.

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