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Background: Laparoscopic bariatric surgery has experienced a rapid expansion of interest over the past 5 years, with a 470% increase. This rapid expansion has markedly increased overall cost, reducing surgical access. Many surgeons believe that the traditional open approach is a cheaper, safer, equally effective alternative. Methods: 16 highly experienced "open" bariatric surgeons with a combined total of 25,759 cases representing >200 surgeon years of experience, pooled their open Roux-en-Y gastric bypass (ORYGBP) data, and compared their results to the leading laparoscopic (LRYGBP) papers in the literature. Results: In the overall series, the incisional hernia rate was 6.4% using the standard midline incision. Utilizing the left subcostal incision (LSI), it was only 0.3%. Return to surgery in

The comorbidities, operative details, complications, and results were reviewed. Results: A total of 310 patients underwent laparoscopic BPD-DS. Of these, 293 were primary procedures, 5 were revisions to BPDDS, and 12 were second-stage procedures. The hospital length of stay for those undergoing nonrevision procedures was 2.3 days. The mortality rate was 0%, the conversion rate was 0.3%, and the leak rate was 1%. The early major complication rate was 3.7%, and the late major complication rate was 2%. Malnutrition requiring hospitalization or reversal occurred in 3 patients (1%). The average preoperative body mass index was 47.8 kg/m (range 36–60). The excess body weight loss at 1 year was 78%, at 2 years was 81%, and at 3 years was 86%. Conclusions: Laparoscopic BPD-DS is as safe as open BPD-DS and open and laparoscopic gastric bypass. The effectiveness to date has been comparable to the results of open BPD-DS. PII: S1550-7289(05)00163-2