Duodenal Switch Compared to Gastric Bypass

Articles that discuss Duodenal Switch Compared to Gastric
Bypass surgery.

Randomized clinical trial of laparoscopic gastric bypass
versus laparoscopic duodenal switch for superobesity.

Søvik et al. Feb 2010

PubMed Abstract

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB)
and laparoscopic biliopancreatic diversion with duodenal
switch (LDS) are surgical options for superobesity. A randomized
trial was conducted to evaluate perioperative (30-day) safety
and 1-year results.

METHODS: Sixty patients with a body
mass index (BMI) of 50-60 kg/m(2) were randomized to LRYGB or
LDS. BMI, percentage of excess BMI lost, complications and
readmissions were compared between groups.

RESULTS: Patient characteristics were similar in the two
groups. Mean operating time was 91 min for LRYGB and 206
min for LDS (P < 0.001). One LDS was converted to open surgery.
Early complications occurred in four patients undergoing
LRYGB and seven having LDS (P = 0.327), with no deaths.
Median stay was 2 days after LRYGB and 4 days after LDS
(P < 0.001). Four and nine patients respectively had late
complications (P = 0.121). Mean BMI at 1 year decreased from
54.8 to 38.5 kg/m(2) after LRYGB and from 55.2 to 32.5 kg/m(2)
after LDS; percentage of excess BMI lost was greater after
LDS (74.8 versus 54.4 per cent; P < 0.001).

CONCLUSION: LRYGB and LDS can be performed with comparable
perioperative safety in superobese patients. LDS provides
greater weight loss in the first year.

Registration number: NCT00327912 (http://www.clinicaltrials.gov).
Copyright (c) 2009 British Journal of Surgery Society Ltd.
Published by John Wiley & Sons, Ltd.

Duodenal switch provides superior resolution of metabolic
comorbidities independent of weight loss in the super-obese
(BMI > or = 50 kg/m2) compared with gastric bypass.

Prachand et al. Feb 2010

PubMed Abstract

OBJECTIVE: Increased body mass index is associated with greater
incidence and severity of obesity-related comorbidities and
inadequate postbariatric surgery weight loss. Accordingly,
comorbidity resolution is an important measure of surgical
outcome in super-obese individuals. We previously reported
superior weight loss in super-obese patients following duodenal
switch (DS) compared to Roux-en-Y gastric bypass (RYGB) in a
large single institution series. We now report follow-up
comparison of comorbidity resolution and correlation with
weight loss.

METHODS: Data from patients undergoing DS and RYGB between
August 2002 and October 2005 were prospectively collected
and used to identify super-obese patients with diabetes,
hypertension, dyslipidemia, and gastroesophageal reflux
disease (GERD). Ali-Wolfe scoring was used to describe
comorbidity severity. Chi-square analysis was used to compare
resolution and two-sample t tests used to compare weight loss
between patients whose comorbidities resolved and persisted.

RESULTS: Three hundred fifty super-obese patients [DS (n=198),
RYGB (n=152)] were identified. Incidence and severity of
hypertension, dyslipidemia, and GERD was comparable in both
groups while diabetes was less common but more severe in the
DS group (24.2% vs. 35.5%, Ali-Wolfe 3.27 vs. 2.94, p<0.05).
Diabetes, hypertension, and dyslipidemia resolution was
greater at 36 months for DS (diabetes, 100% vs. 60%; hypertension,
68.0% vs. 38.6%; dyslipidemia, 72% vs. 26.3%), while GERD
resolution was greater for RYGB (76.9% vs. 48.57%; p<0.05).
There were no differences in weight loss between comorbidity
“resolvers” and “persisters”.

CONCLUSIONS: In comparison to RYGB, DS provides superior
resolution of diabetes, hypertension, and dyslipidemia in
the super-obese independent of weight loss.

Vitamin status after bariatric surgery: a randomized
study of gastric bypass and duodenal switch.

Aasheim et al. July 2009

PubMed Abstract

BACKGROUND: Bariatric surgery is widely performed to induce
weight loss.

OBJECTIVE: The objective was to examine changes in vitamin
status after 2 bariatric surgical techniques.

DESIGN: A randomized controlled trial was conducted in 2
Scandinavian hospitals. The subjects were 60 superobese
patients [body mass index (BMI; in kg/m(2)): 50-60]. The
surgical interventions were either laparoscopic Roux-en-Y
gastric bypass or laparoscopic biliopancreatic diversion
with duodenal switch. All patients received multivitamins,
iron, calcium, and vitamin D supplements. Gastric bypass
patients also received a vitamin B-12 substitute. The patients
were examined before surgery and 6 wk, 6 mo, and 1 y after

RESULTS: Of 60 surgically treated patients, 59 completed the
follow-up. After surgery, duodenal switch patients had lower
mean vitamin A and 25-hydroxyvitamin D concentrations and a
steeper decline in thiamine concentrations than did the gastric
bypass patients. Other vitamins (riboflavin, vitamin B-6,
vitamin C, and vitamin E adjusted for serum lipids) did not
change differently in the surgical groups, and concentrations
were either stable or increased. Furthermore, duodenal switch
patients had lower hemoglobin and total cholesterol concentrations
and a lower BMI (mean reduction: 41% compared with 30%) than
did gastric bypass patients 1 y after surgery. Additional
dietary supplement use was more frequent among duodenal switch
patients (55%) than among gastric bypass patients (26%).

CONCLUSIONS: Compared with gastric bypass, duodenal switch
may be associated with a greater risk of vitamin A and D
deficiencies in the first year after surgery and of thiamine
deficiency in the initial months after surgery. Patients who
undergo these 2 surgical interventions may require different
monitoring and supplementation regimens in the first year after
surgery. This trial was registered at ClinicalTrials.gov as

Bowel Habits after Gastric Bypass Versus the Duodenal
Switch Operation.

Wasserberg et al. Aug 2008

PubMed Abstract

BACKGROUND: One of the perceived disadvantages of the biliopancreatic
diversion with duodenal switch operation is diarrhea. The
aim of this study was to compare the bowel habits of patients
after duodenal switch operation or Roux-en-Y gastric bypass.

METHODS: A prospective comparative case series design was
used. Forty-six patients who underwent duodenal switch (n = 28)
or gastric bypass (n = 18) were asked to complete a daily
diary for 14 days after losing least 50% of their excess
body weight. Data were collected on number of bowel episodes,
incontinence, urgency, stool consistency, and awakening from
sleep to defecate. Background variables were recorded from
the medical files.

RESULTS: The duodenal switch group was heavier (body mass
index 53.5 vs 47.0 kg/m(2), p = 0.03) and older (47.5 vs
41.0 years, p = NS) than the gastric bypass group. Median
time to 50% excess body weight loss was 22 months in the
duodenal switch group compared to 10.0 months in the gastric
bypass group (p = 0.001). Patients after duodenal switch
surgery reported a median of 23.5 bowel episodes over the
14-day study period compared to 16.5 in the gastric bypass
group (p = NS). There was no between-group differences in
any of the other bowel parameters studied.

CONCLUSIONS: Although duodenal switch is associated with
more bowel episodes than gastric bypass, the difference is
not statistically significant. Bowel habits are similar in
patients who achieve 50% estimated body weight loss with
duodenal switch surgery or gastric bypass.

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

Prachand et al. Oct 2006

PubMed Abstract

OBJECTIVES: 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).

METHODS: 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.

RESULTS: 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).

CONCLUSIONS: Direct comparison of DS to RYGB demonstrates
superior weight loss outcomes for DS.

Roux-en-Y gastric bypass versus a variant of biliopancreatic
diversion in a non-superobese population: prospective
comparison of the efficacy and the incidence of metabolic

Skroubis et al. April 2006

PubMed Abstract

BACKGROUND: In the non-superobese population, an agreement
has not been made as to the optimal bariatric operation. The
present study reports the results of a prospective comparison
of Roux-en-Y gastric bypass (RYGBP) and a variant of biliopancreatic
diversion (BPD) in a non-superobese population.

METHODS: From a cohort of 130 patients with BMI 35 to 50
kg/m(2), 65 patients were randomly selected to undergo RYGBP
and 65 to undergo BPD. All patients underwent complete follow-up
evaluation at 1, 3, 6, and 12 months postoperatively and
every year thereafter.

RESULTS: Patients in both groups have completed their second
postoperative year. Mean % excess weight loss (%EWL) was
significantly better after BPD at all time periods (12 months,
P=0.0001 and 24 months, P=0.0003), and the %EWL was >50%
in all BPD patients compared to 88.7% in the RYGBP patients
at 2-year follow-up. No statistically significant differences
were observed between the 2 groups in early and late non-metabolic
complications. Hypoalbuminemia occurred in only 1 patient
(1.5%) after RYGBP and in 6 patients after BPD (9.2%). Only
1 patient from each group was hospitalized and received
total parenteral nutrition. Glucose intolerance, hypercholesterolemia,
hypertriglyceridemia and sleep apnea completely resolved
in all patients in both groups, although mean total cholesterol
level was significantly lower in BPD patients at the second
year follow-up (t-test, P<0.0001). Diabetes completely resolved
in all BPD patients and in 7 of the 10 diabetic RYGBP patients.

CONCLUSION: Both RYGBP and BPD were safe and effective procedures
when offered to non-superobese patients. Weight loss after
BPD was consistently better than that after RYGBP, as was
the resolution of diabetes and hypercholesterolemia. Because
the nutritional deficiencies that occurred following this
type of BPD were not severe and were not significantly
different between the 2 operations, both may be offered to
non-superobese patients, keeping in mind the severity and
type of preoperative co-morbidities as well as the desired
weight loss.