Obesity Surgery

, Volume 19, Issue 11, pp 1485–1490 | Cite as

Short-Term Morbidity and Mortality After Open Versus Laparoscopic Gastric Bypass Surgery. A Population-Based Study from Sweden

  • Richard MarskEmail author
  • Per Tynelius
  • Finn Rasmussen
  • Jacob Freedman
Clinical Research



The number of anti-obesity procedures performed continues to increase and most are now performed laparoscopically. Few population-based studies have examined outcomes after open and laparoscopic anti-obesity surgery.


All-cause mortality and cause-specific morbidity was studied in patients who underwent laparoscopic or open gastric bypass (GBP) surgery in all public Swedish hospitals between 1997 and 2006.


Four thousand seven hundred one (3,852 primary) GBP procedures were performed during the study period. Of these, 1,661 were performed laparoscopically and 3,040 by open access. There was no difference in 30-, 90-, or 365-day mortality between open and laparoscopic access. Complications were more common after conversion from previous anti-obesity surgery to GBP (OR 1.9; 95% CI 1.5–2.4; 30-day readmission). Surgical re-intervention due to anastomotic leak or deep infection was higher in laparoscopic GBP compared to open GBP (OR 2.1; 1.3–3.6). Subgroup analysis showed higher leak rates with revisional laparoscopic procedures (conversion to GBP from previous anti-obesity surgery) compared to revisional open (OR 4.1; 1.5–11.2) whereas after primary GBP no statistically significant difference was seen between laparoscopic and open approach (OR 1.7; 1.0–3.1) (p = 0.07).


Laparoscopic GBP is as safe as open surgery in terms of mortality. Care needs to be taken when converting previous anti-obesity surgery to GBP.


Gastric bypass Obesity Bariatric surgery Morbidity Mortality Epidemiology Cohort study 



This study was supported by the Swedish Research Council, Stockholm Council and Funds of the Karolinska Institutet.


None of the authors have any conflict of interest and nothing to declare.


  1. 1.
    Sjöström L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.CrossRefGoogle Scholar
  2. 2.
    Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.CrossRefGoogle Scholar
  3. 3.
    Buchwald H, Estok R, Fahrbach K, et al. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery. 2007;142:621–35.CrossRefGoogle Scholar
  4. 4.
    Marsk R, Freedman J, Tynelius P, et al. Anti-obesity surgery in Sweden 1980–2005: population based study with focus on mortality. Ann Surg. 2008;248:777–81.CrossRefGoogle Scholar
  5. 5.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.CrossRefGoogle Scholar
  6. 6.
    Weller WE, Rosati C. Comparing outcomes of laparoscopic versus open bariatric surgery. Ann Surg. 2008;248:10–5.CrossRefGoogle Scholar
  7. 7.
    Schirmer B. Laparoscopic bariatric surgery. Surg Endosc. 2006;20:S450–5.CrossRefGoogle Scholar
  8. 8.
    Nguyen NT, Hinojosa M, Fayad C, et al. Use and outcomes of laparoscopic versus open gastric bypass at academic medical centers. J Am Coll Surg. 2007;205:248–55.CrossRefGoogle Scholar
  9. 9.
    Nguyen NT, Goldman C, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life and costs. Ann Surg. 2001;234:279–89.CrossRefGoogle Scholar
  10. 10.
    Lujan JA, Frutos DA, Hernandez Q, et al. Laparoscopic versus open gastric bypass in the treatment of morbid obesity. Ann Surg. 2004;239:433–7.CrossRefGoogle Scholar
  11. 11.
    Nguyen NT, Silver M, Robinson M, et al. Result of a national audit of bariatric surgery performed at academic centers: a 2004 University HealthSystem Consortium Benchmarking Project. Arch Surg. 2006;141:445–9.CrossRefGoogle Scholar
  12. 12.
    Te Riele WW, Sze YK, Wiezer MJ, et al. Conversion of failed laparoscopic gastric banding to gastric bypass as safe and effective as primary gastric bypass in morbidly obese patients. Surg Obes Relat Dis. 2008;4(6):735–9.CrossRefGoogle Scholar
  13. 13.
    Nesset EM, Kendrick ML, Houghton SG, et al. A two-decade spectrum of revisional bariatric surgery at a tertiary referral center. Surg Obes Relat Dis. 2007;3:25–30.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2009

Authors and Affiliations

  • Richard Marsk
    • 1
    Email author
  • Per Tynelius
    • 2
  • Finn Rasmussen
    • 2
  • Jacob Freedman
    • 1
  1. 1.Division of Surgery, Department of Clinical Sciences, Danderyd HospitalKarolinska InstitutetStockholmSweden
  2. 2.Department of Public Health SciencesKarolinska InstitutetStockholmSweden

Personalised recommendations