Most recent update: Tuesday, September 19, 2017 - 17:23

Bariatric News - Cookies & privacy policy

You are here

Duodenal switch vs. RYGB

DS betters RYGB for patients with BMI 50-60

Duodenal switch was associated with more long-term surgical and nutritional complications
Patients with duodenal switch underwent more surgical procedures related to the initial procedure

Biliopancreatic diversion with duodenal switch resulted in more weight loss and better improvement in blood lipids and glucose five years after surgery, compared with usual gastric bypass surgery but duodenal switch was associated with more long-term surgical and nutritional complications and more adverse gastrointestinal effects, according to a report published in JAMA Surgery.

Dr Hilde Risstad

The article by Dr Hilde Risstad from Oslo University Hospital, Norway, and co-authors state that these is no consensus as to which bariatric procedure is preferred to reduce weight and improve health in patients with a BMI> 50. Therefore, they decided to compare five-year outcomes after Roux-en-Y gastric bypass (gastric bypass) and biliopancreatic diversion with duodenal switch (duodenal switch).

Between March 2006 and August 2007, 60 patients aged 20 to 50 years with a BMI50 to 60 received either a gastric bypass (n = 31) or duodenal switch (n = 29). Fifty-five patients (92%) completed the study.

The primary end point of the trial was change in BMI at two years and secondary outs were anthropometric measures, cardiometabolic risk factors, pulmonary function, vitamin status, gastrointestinal symptoms, health-related quality of life, and adverse events.

Outcomes

Five years after surgery, the mean reductions in body mass index were 13.6 and 22.1 after gastric bypass and duodenal switch, respectively. The mean between-group difference was 8.5 (<0.001). Total body weight loss was 26.4% after gastric bypass and 40.3% after duodenal switch at five years’ follow-up (p<0.001). Mean weight regain from nadir at one or two years after the procedure to the end of the study was 9.9kg after gastric bypass and 8.7kg after duodenal switch; the mean between-group difference was 1.7kg. After five years, 15 patients with gastric bypass (55.6%) and four patients with duodenal switch (14.3%) had a BMI of more than 40 (p =0.001).

Remission rates of type 2 diabetes mellitus and metabolic syndrome and changes in blood pressure and lung function were similar between groups. Reductions in total cholesterol, low-density lipoprotein cholesterol, triglycerides, and fasting glucose were significantly greater after duodenal switch compared with gastric bypass. Serum concentrations of vitamin A and 25-hydroxyvitamin D were significantly reduced after duodenal switch compared with gastric bypass.

Duodenal switch was associated with more gastrointestinal adverse effects. Health-related quality of life was similar between groups. Patients with duodenal switch underwent more surgical procedures related to the initial procedure (13 vs 3 patients; p=0.002) and had significantly more hospital admissions compared with patients with gastric bypass.

One or more adverse events occurred in 21 patients with gastric bypass (67.7%) and 23 patients with duodenal switch (p=0.31). Nine patients with gastric bypass (29.0%) and 17 patients with duodenal switch (58.6%) were admitted to the hospital for any reason during the first five years after surgery (p=0.02). Additional surgical interventions related to the initial procedure were performed in three patients with gastric bypass (9.7%) and 13 patients with duodenal switch (p=0.002).

The researchers said that the benefits of duodenal switch should be balanced against the risks of adverse events, quality of life and additional healthcare costs.

“In our study, duodenal switch resulted in greater weight loss and greater improvements in blood lipids and glucose compared with gastric bypass across 5 years in patients with baseline BMIs of 50 to 60,” conclude the authors. “Improvements in HRQL were comparable. However, duodenal switch was associated with more long-term surgical and nutritional complications and more gastrointestinal adverse effects compared with gastric bypass.”

In a related commentary, Dr Oliver A Varban and Justin B Dimick of the University of Michigan, Ann Arbor, commented: "Given the high complication rates of duodenal switch in the study by Risstad et al, it is difficult to recommend duodenal switch as a first-line weight loss procedure. At the very least, patients seeking this procedure should receive ample warning regarding the very high risks of adverse nutritional outcomes and the high reoperation rate. Patients with poor compliance and poor follow-up should not be offered this procedure because they could be at risk of fatal complications if postoperative problems are not addressed in a timely fashion."

To access this paper, please click here

Want more stories like this? Subscribe to Bariatric News!

Bariatric News
Keep up to date! Get the latest news in your inbox.