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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