Laparoscopic Roux-en-Y Gastric Bypass vs. Laparoscopic Adjustable Gastric Banding: 30-day Morbidity and Mortality as Assessed by Prospective, Multi-center, Risk-Adjusted ACS-NSQIP Data

Background: Previous comparisons of open and laparoscopic Roux-en-Y gastric bypass (ORYGB, LRYGB), and laparoscopic adjustable gastric banding (LAGB) have been limited by a lack of unique CPT codes for LRYGB and LAGB. Specific codes have been available for LRYGB since 2005, and for LAGB since 2006. This study compares the short-term safety of these procedures, using risk-adjusted clinical data from a multi-institutional quality improvement program.
Methods: The ACS-NSQIP Participant Use File was used to compare patients from academic and community hospitals (in 2006, n=72; n=49 respectively) who underwent LRYGB with those who underwent ORYGB or LAGB.
Results: After risk-adjustment, ORYGB (vs LRYGB) demonstrated a higher rate of major complication (OR=2.04; [1.54, 2.70]). In contrast, LAGB (vs LRYGB) showed a lower risk of major complication (OR=0.30; [0.17, 0.55]).
Conclusions: Compared to LRYGB, ORYGB is associated with higher 30-day mortality, and a higher risk-adjusted major complication rate. While ORYGB is indicated for some, a laparoscopic approach may be safer for RYGB when feasible. LAGB, compared to LRYGB, has a similarly low mortality rate and a small but statistically significant decrease in risk-adjusted 30-day complication rate. However, clinical efficacy and outcomes beyond 30 days are not evaluated in this study.

Session: Podium Presentation

Program Number: S078

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