Duodenal Switch Compared to Other Weight Loss Surgeries

Clinical data discussing results of Duodenal Switch compared
to other weight loss surgeries including Adjustable Gastric
Band, Vertical Sleeve Gastrectomy or Gastric Bypass.

Perioperative complications in a consecutive series of
1000 duodenal switches.

Marceau et al. Nov 2011

PubMed Abstract

BACKGROUND: In the past 10 years, most bariatric surgeries
have seen an important reduction in the early complication
rate, partly associated with the development of the laparoscopic
approach. Our objective was to assess the current early
complication rate associated with biliopancreatic diversion
with duodenal switch (BPD-DS) since the introduction of a
laparoscopic approach in our institution, a university-affiliated
tertiary care center.

METHODS: A consecutive series of 1000 patients who had undergone
BPD-DS from November 2006 to January 2010 was surveyed. The
primary endpoint was the mortality rate. The secondary endpoints
were the major 30-day complication rate and hospital stay >10
days. The data are reported as a mean ± SD, comparing the
laparoscopic (n = 228) and open (n = 772) groups.

RESULTS: The mean age of the patients was 43 ± 10 years
(40 ± 10 years in the laparoscopy group versus 44 ± 10 years
in the open group, P < .01). The preoperative body mass
index was 51 ± 8 kg/m(2) (47 ± 7 laparoscopy versus 52 ±
8 kg/m(2) open, P < .01). The conversion rate in the laparoscopy group was 2.6%. There was 1 postoperative death (.1%) from a pulmonary embolism in the laparoscopy group. The mean hospital stay was shorter after laparoscopic surgery (6 ± 6 d versus 7 ± 9 d, P = .01), and a hospital stay >10 days was more
frequent in the open group (4.4% versus 7%, P = .04). Major
complications occurred in 7% of the patients, with no significant
differences between the 2 groups (7% versus 7.4%, P = .1). No
differences were found in the overall leak or intra-abdominal
abscess rate (3.5% versus 4%, P = .1); however, gastric leaks
were more frequent after open surgery (0% versus 2%, P = .02).
During a mean 2-year follow-up, 1 additional death occurred
from myocardial infarction, 2 years after open BPD-DS.

CONCLUSION: The early and late mortality rate of BPD-DS is
low and comparable to that of other bariatric surgeries.

Effect of different bariatric operations on food tolerance
and quality of eating.

Schweiger et al. Oct 2010

PubMed Abstract

ABSTRACT: Many bariatric operations are associated with reduced
food tolerance and frequent vomiting, which may cause nutritional
deficiencies and influence quality of life. However, the impact
of different bariatric procedures on quality of eating and food
tolerance has not yet been studied enough. Two hundred and
eighteen participants filled a quality of eating questionnaire,
at three different time periods after bariatric operation:
short-term (3-6 months, n=63), medium-term (6-12 months, n=69)
and long-term follow-up (over 12 months, n=86). The participants
underwent the following procedures: 99 patients have had
Roux-en-Y gastric bypass (RYGB), 49 laparoscopic gastric
banding (LAGB), 56 sleeve gastrectomy (SG), and 14

biliopancreatic diversion with duodenal switch (BPD-DS)

. At short-term period score achieved for all section of
the questionnaire was similar for all operations. The total
score of the questionnaire at the medium-term group was
20.27 +/- 3.57, 14.47 +/- 5.92, 22.27 +/- 4.66, and
20.91 +/- 3.26 (p<0.001) and the total score for the
long-term group of was 21.56 +/- 5.16, 15.5 +/- 3.75, 20.45
+/- 4.9, and 24.2 +/- 2.16 (p<0.001) for RYGB, LAGB,
SG, and BPD-DS, respectively. In a linear regression
model we found that LAGB patients had a significantly lower
total score compared to all other procedures (p<0.001). Every
1% of %EWL was associated with a total score decrease in
0.045 points (p=0.009). Impaired quality of eating and food
intolerance is common following many types of bariatric
procedures. However, the difficulties diminish as time passes
after operation and can be affected by the type of procedure.
Patients undergoing LAGB have significantly greater limitations
and difficulties to ingest variety of foods.

Comparison of weight loss and body composition changes
with four surgical procedures.

Gagner et al. April 2009

PubMed Abstract

BACKGROUND: A paucity of information is available on the
comparative body composition changes after bariatric procedures.
The present study reports on the body mass index (BMI) and
body composition changes after 4 procedures by a single group.

METHODS: At the initial consultation, the weight and body
composition of the patients undergoing 4 different bariatric
procedures were measured by bioimpedance (Tanita 310). Follow-up
examinations were performed at 1 year and at subsequent visits
after surgery. Analysis of variance was used to compare the
postprocedure BMI and body composition. Analysis of covariance
was used to adjust for baseline differences.

RESULTS: A total of 101 gastric bypass (GB) patients were
evaluated at 19.1 +/- 10.6 months, 49 biliopancreatic diversion
with the duodenal switch (BPD/DS) patients at 27.5 +/- 16.3
months, 41 adjustable gastric band (AGB) patients at 21.4
+/- 9.2 months, and 30 sleeve gastrectomy (SG) patients at
16.7 +/- 5.6 months (P <.0001). No differences were found
in patient age or gender among the 4 groups. The mean preoperative
BMI was significantly different among the 4 groups (P <.0001):
61.4 kg/m(2), 53.2, 46.7, and 44.3 kg/m(2) for the SG, BPD/DS,
GB, and AGB group, respectively. The postoperative BMI adjusted
for baseline differences was 27.8 (difference 23.6 +/- 8.3),
32.5 (difference 15.6 +/- 5.0), 37.2 (difference 18.2 +/- 8.2),
and 39.5 kg/m(2) (difference 7.5 +/- 4.3) for the BPD/DS, GB,
SG, and AGB groups, respectively (P <.0001). The percentage
of excess weight loss was 84%, 70%, 49%, and 38% for the BPD/DS,
GB, SG, and AGB groups, respectively (P <.0001). The postoperative
percentage of body fat adjusted for baseline differences was 25.7%
(23.9% +/- 7.0%) 32.7% (16.1% +/- 10.5%) 37.7% (16.7% +/- 5.6%),
and 42% (6.0% +/- 6.8%) for the BPD/DS, GB, SG, and AGB groups,
respectively (P <.0001). The lean body mass changes were reciprocal.

CONCLUSION: Although the BPD/DS procedure reduced the BMI the
most effectively and promoted fat loss, all the procedures produced
weight loss. The AGB procedure resulted in less body fat loss
within 21.5 months than SG within 16.7 months. Longer term
observation is indicated.


Obesity surgery results depending on technique performed:
long-term outcome.

Gracia et al. April 2009

PubMed Abstract

BACKGROUND: Many techniques have excellent results at 2 years
of follow-up but some matters regarding their long-term efficacy
have arisen. This is why bariatric surgery results must be
analyzed in long-term follow-up. The aim of this study was
to extend the analysis over 5 years, evaluating weight loss,
morbidity, and mortality of the surgical procedures performed.

METHODS: This was a retrospective cohort study of the different
procedures for morbid obesity practiced in our Department of
Surgery for morbid obesity. The results have been analyzed in
terms of weight loss, morbidity improvement, and postoperative
morbidity (Bariatric Analysis And Reporting Outcome System).

RESULTS: One hundred twenty-five patients were operated on
open vertical banded gastroplasty (VBG), 150 patients of
open biliopancreatic diversion (BPD) of Scopinaro, 100 patients
of open modified BPD (common limb 75 cm; alimentary limb 225 cm),
and 115 patients of laparoscopic Roux-en-Y gastric bypass (LRYGBP).
Mean follow-up was: VBG 12 years, BPD 7 years, and LRYGBP 4
years. An excellent initial weight loss was observed at the
end of the second year of follow-up in all techniques, but
from this time an important regain of weight was observed in
VBG group and a discrete weight regain in LRYGBP group. Only
BPD groups kept excellent weight results so far in time.
Mortality was: VBG 1.6%, BPD 1.2%, and LRYGBP 0%. Early postoperative
complications were: VBG 25%, BPD 20.4%, and LRYGBP 20%. Late
postoperative morbidity was: protein malnutrition 11% in
Scopinaro BPD, 3% in Modified BPD group, and no cases reported
either in VBG group or LRYGBP group; iron deficiency 20% VBG,
62% Scopinaro BPD, 40% modified BPD, and 30.5% LRYGBP. A 14.5%
of VBG group required revision surgery to gastric bypass or
to BPD due to 100% weight regain or vomiting. A 3.2% of Scopinaro
BPD with severe protein malnutrition required revision surgery
to lengthen common limb to 100 cm. A 0.8% of LRYGBP required
revision surgery to distal LRYGBP (common limb 75 cm) due to
100% weight regain.

CONCLUSIONS: The most complex bariatric procedures increase
the effectiveness but unfortunately they also increase morbidity
and mortality. LRYGBP is safe and effective for the treatment
of morbid obesity. Modified BPD (75-225 cm) can be considered
for the treatment of superobesity (body mass index > 50 kg/m(2)),
and restrictive procedures such as VBG should only be performed
in well-selected patients due to high rates of failure in
long-term follow-up.