ObjectiveTo compare outcomes, quality of life (QOL), and costs of laparoscopic and open gastric bypass (GBP). Summary Background DataLaparoscopic 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. MethodsFrom May 1999 to March 2001, 155 patients with a body mass index (BMI) of 40 to 60 kg/m 2 were randomly assigned to undergo laparoscopic (n ϭ 79) or open (n ϭ 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. ResultsThere 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. ConclusionsLaparoscopic 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.Obesity is a burgeoning healthcare problem in the United States.1 The prevalence of obesity (body mass index [BMI]Ն30 kg/m 2 ) increased from 12.0% in 1991 to 17.9% in 1998.2 This trend will likely worsen because more than 25% of American children are obese. Obesity is a wellestablished risk factor for the development of coronary heart disease,...

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Cost-effectiveness of four age-related mammographic screening strategies was evaluated. The MCYLS for all strategies was within a generally accepted range. With increasing concerns regarding the cost of health care, this information may be useful in health policy decision-making.

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The MCYLS is 19% greater for CAD added to screening versus screening mammography alone but is still within the accepted range for cost-effectiveness.