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Duodenal switch associated with more risk, weight loss compared with gastric bypass
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Morbidly obese patients who underwent duodenal switch experienced more early complications but superior weight loss and comorbidity control compared with patients receiving gastric bypass in a recent study.
In a retrospective review, researchers evaluated inpatient, outpatient and follow-up data from 1,545 patients who received biliopancreatic diversion/duodenal switch (DS) and 77,406 who underwent gastric bypass (GB) between 2007 and 2010.
After 6 months, GB patients had lost a significantly greater mean percentage of excess BMI (58% compared with 56%), but participants in the DS group lost more weight after 2 years or longer (85% compared with 79%, P<.001). Change in BMI also was significantly greater among the DS group than the GB group after 2 years (43% vs. 36%).
Among evaluable participants with a BMI greater than 50, DS patients experienced more excess body weight loss after 2 years (79% of body weight compared with 67%; P<.01). Patients in the DS group also were less likely to experience weight-loss failure, defined as failing to shed at least 50% of excess body weight, particularly among those with a BMI above 50 (20% vs. 9% at 1 year; 20% vs. 6% at 2 years). Comorbidities, including diabetes, hypertension and sleep apnea, also improved or resolved more frequently in the DS group (P<.01 for all) compared with GB.
Operative time (191 minutes vs. 114), estimated blood loss (132 mL3 vs. 54 mL3) and length of hospital stay (4.4 days vs. 2.4 days) were all greater among patients who underwent DS (P<.001 for all). DS patients also were more prone to post-operative infection than GB patients (4.5% vs. 1.9%; P<.001), anastomotic leaks (1.6% vs. 0.8%; P<.001), nutritional deficiency (4.1% vs. 2.1%; P<.001) and death (1.2% vs. 0.3%; P<.001).
“Although the DS carries a higher relative risk profile than GB, the absolute risk is low,” the researchers wrote. “Among morbidly obese patients, the DS results in superior sustained weight reduction and improved comorbidity control compared with GB, which may outweigh early perioperative risk. … Further studies of this procedure to determine the optimal patient selection, operative technique and longer-term risks vs. outcomes are warranted.”
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