OBJECTIVES: The goal of this study was to compare the health care resource utilization and costs between obese patients who received laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (lRYGB), open Roux-en-Y gastric bypass (oRYGB), and sleeve gastrectomy (SG).  METHODS: Marketscan claims data (2005 to 2010) were analyzed for patients ≥18 years old, who received LAGB, lRYGB, oRYGB, or SG (identified using ICD-9-CM and CPT codes) and  remained continuously insured for ≥12 months following first date of surgery (index date).  Patients with ambiguous bariatric procedure coding or stomach or intestinal cancer codes were excluded.  RESULTS: A total of 52,359 claims met inclusion criteria: LAGB (n=21,075), lRYGB (n=26,206), oRYGB (n=4,497), and SG (n=581), averaging 44 to 46 years old and about 80% female.  35.5% LAGB had type II diabetes codes compared to lRYGB (40.6%), oRYGB (42.3%), and SG (40.8%).  10.0% of the LAGB patients were hospitalized within 12 months post-index date compared to lRYGB (17.4%), oRYGB (20.5%), and SG (13.8%).  LOS were 4.9, 6.0, 9.3, and 10.0 days; total costs were $21,242 vs. $22,988; $31,603; and $35,631; respectively.  In the diabetic subgroup, 12.1% LAGB, 19.2% lRYGB, 23.9%  oRYGB, and 17.3%  SG were hospitalized within 12 months.  LOS were 5.4, 6.4, 10.4, and 11.3 days; total costs were $22,840; $24,816; $37,698; and $35,128; respectively.  Similarly, out of those with 36-month follow-up data, 29.0% (1162/4012) LAGB patients were hospitalized compared to 36.5% (3000/8218) lRYGB, 41.0% (852/2078) oRYGB, and 13.8% (79/234) SG.  LOS were 5.4, 6.6, 7.6, and 6.4 days, respectively; and total costs were $24,973 (LAGB); $27,280 (lRYGB); $26,754 (oRYGB); and $26,948 (SG).  CONCLUSIONS: LAGB had the lowest all-cause hospitalization rate and costs during follow-up periods and within the diabetic subgroup.  Results, however, could be due to other factors like baseline imbalances; further research will assess if trend remains after stratifying for differences in underlying comorbidities.