Duodenal Switch Provides Superior Weight Loss in the Super-Obese (BMI ≥50kg/m2) Compared With Gastric Bypass

University of Chicago, Chicago, IL 60637, USA.
Annals of Surgery (Impact Factor: 8.33). 11/2006; 244(4):611-9. DOI: 10.1097/01.sla.0000239086.30518.2a
Source: PubMed


Although weight loss following Roux-en-Y gastric bypass is acceptable in patients with preoperative body mass index (BMI) between 35 and 50 kg/m, results from several series demonstrate that failure rates approach 40% when BMI is > or =50 kg/m. Here we report the first large single institution series directly comparing weight-loss outcomes in super-obese patients following biliopancreatic diversion with duodenal switch (DS) and Roux-en-Y Gastric Bypass (RYGB).
All super-obese patients (BMI > or =50 kg/m) undergoing standardized laparoscopic and open DS and RYGB between August 2002 and October 2005 were identified from a prospective database. Two-sample t tests were used to compare weight loss, decrease in BMI, and percentage of excess body weight loss (% EBWL) after surgery. chi analysis was used to determine the rate of successful weight loss, defined as achieving at least 50% loss of excess body weight.
A total of 350 super-obese patients underwent DS (n = 198) or RYGB (n = 152) with equal 30-day mortality (DS,1 of 198; RYGB, 0 of 152; P = not significant). The % EBWL at follow-up was greater for DS than RY (12 months, 64.1% vs. 55.9%; 18 months, 71. 9% vs. 62.8%; 24 months, 71.6% vs. 60.1%; 36 months, 68.9% vs. 54.9%; P < 0.05). Total weight loss and decrease in BMI were also statistically greater for the DS (data not shown). Importantly, the likelihood of successful weight loss (EBWL >50%) was significantly greater in patients following DS (12 months, 83.9% vs. 70.4%; 18 months, 90.3% vs. 75.9%; 36 months, 84.2% vs. 59.3%; P < 0.05).
Direct comparison of DS to RYGB demonstrates superior weight loss outcomes for DS.

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    • "Preoperative BMI was significantly greater in the BPD/DS group compared to the RYGB group (58.8 kg/m2 versus 56.4 kg/m2, P = 0.0014). Percentage of EBWL was found to be significantly greater in the BPD/DS group compared to RYGB (12 months, 64.1% versus 55.9%; 18 months, 71.9% versus 62.8%; 24 months, 71.6% versus 60.1%; 36 months, 68.9% versus 54.9%) [19]. Contrarily, Deveney et al. compared weight loss after 1 and 2 years in super-obese patients who underwent RYGB or BPD/DS and reported percentage of EBWL to be similar between the 2 groups: 54% versus 53% at 1 year and 67% versus 64% at 2 years, with longer length of stay and higher rates of anastomotic leak in the BPD/DS group. "
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    ABSTRACT: The prevalence of morbidly obese individuals is rising rapidly. Being overweight predisposes patients to multiple serious medical comorbidities including type two diabetes (T2DM), hypertension, dyslipidemia, and obstructive sleep apnea. Lifestyle modifications including diet and exercise produce modest weight reduction and bariatric surgery is the only evidence-based intervention with sustainable results. Biliopancreatic diversion (BPD) produces the most significant weight loss with amelioration of many obesity-related comorbidities compared to other bariatric surgeries; however perioperative morbidity and mortality associated with this surgery are not insignificant; additionally long-term complications including undesirable gastrointestinal side effects and metabolic derangements cannot be ignored. The overall quality of evidence in the literature is low with a lack of randomized control trials, a preponderance of uncontrolled series, and small sample sizes in the studies available. Additionally, when assessing remission of comorbidities, definitions are unclear and variable. In this review we explore the pros and cons of BPD, a less well known and perhaps underutilized bariatric procedure.
    Gastroenterology Research and Practice 11/2013; 2013:974762. DOI:10.1155/2013/974762 · 1.75 Impact Factor
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    ABSTRACT: There is no clear consensus as to which is the best operation in bariatric surgery. Perhaps a better question is, “Which is the right operation for the given patient?” No operation is uniformly accepted as the best one. There are too many confounding factors to make this kind of decision making possible. Primarily, the lack of long-term follow-up, established definitions of success, and paucity of randomized data make this unfeasible. In addition, patients may have different goals or biases that determine which operation they choose. Importantly, not all bariatric surgeons perform all bariatric procedures. The preceding sections have reported the outcomes of laparoscopic adjustable banding (LAGB), roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and the biliopancreatic diversion/duodenal switch (DS) operation. Specific considerations have also been covered for adolescent patients. This chapter attempts to put these data into perspective and offer recommendations that are suitable for a particular patient or clinical circumstance. The appropriate choice of operation begins with a full assessment of the patient’s reasons for choosing as well as expectations of weight loss surgery. Information can then be gathered from the history and physical examination, laboratory data, imaging and endoscopic studies, and prior operative notes. Arbitrarily, choice of procedure can be determined by weight, presence of comorbid illness, age, plans of conception, or relevant previous surgery. Collectively, some of these factors can be used to determine a patient’s perioperative risk, which might represent an independent way to choose an operation. For example, what would be the best operation for a 26-year-old superobese man with a history of a previous Nissen fundoplication? Certainly even the most singularly aligned surgeon to a particular operation might give pause to the fact that there needs to be particular consideration in this case and that his or her “best” operation, or any operation for that matter, may not be appropriate. The four most commonly performed procedures for morbid obesity at this time are RYGB, LAGB, DS, and SG. Each procedure has advantages and disadvantages; accordingly, it is important to consider multiple factors when recommending the type of surgery. Few randomized trials exist comparing the different procedures. Algorithms using review of the literature have been developed to match a given patient to a given operation. This algorithm has not yet been tested in a clinical setting and cannot be absolute.
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    ABSTRACT: There is currently an increasing role for bariatric surgery in the treatment of obesity. However, not all patients experience a successful outcome in terms of weight loss achieved. Failure to attain sufficient weight loss or weight regain may be attributed to numerous factors. It is essential to adequately evaluate these patients to determine if they have behavioral issues that might be responsible for their weight loss failure. If a structural cause is identified it might be necessary to revise the primary operation with an aim to produce further weight loss.
    09/2013; 1(3). DOI:10.1007/s40137-013-0022-1
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