Duodenal Switch Is Superior to Gastric Bypass in Patients with Super Obesity when Evaluated with the Bariatric Analysis and Reporting Outcome System (BAROS)

Abstract

BackgroundIt is not clear which bariatric procedure that gives the best outcome for patients with super obesity (body mass index [BMI] > 50 kg/m2). This study aims to compare outcomes in patients with super obesity after Roux-en-Y gastric bypass (RYGB) and duodenal switch (BPD/DS) using the Bariatric Analysis and Reporting Outcome System (BAROS) and a local questionnaire for gastrointestinal symptoms.MethodsA retrospective mail survey including 211 patients, 98 RYGB and 113 BPD/DS, with a mean follow-up time of 4 years for both groups. Gender distribution, age, and comorbidities were similar. Weight loss, changes in comorbidities, quality of life (QoL), and adverse events were registered, as well as gastrointestinal symptoms.ResultsPreoperative BMI was higher in the BPD/DS group (56 ± 6.7 vs. 52 ± 4.0 kg/m2, p < 0.01); despite this, the postoperative BMI was lower (31 ± 5.5 vs. 36 ± 7.1 kg/m2, p < 0.01). The effect on diabetes was superior after BPD/DS; otherwise, both groups had a similar reduction in comorbidities. There was no difference in QoL. Adverse events were less common after RYGB (14 vs. 27%). Overall, the BPD/DS group had a superior BAROS score (4.7 ± 2.0 vs. 4.0 ± 2.1, p < 0.05). Dumping was more common after RYGB (p < 0.01), while reflux, diarrhea, fecal incontinence, and problems with malodorous flatus were more common after BPD/DS (all p < 0.05). Frequency of nausea/vomiting and abdominal pain were similar.ConclusionPatients with super obesity have a better weight reduction and metabolic control with BPD/DS, at the cost of higher incidence of adverse events, compared to patients operated with RYGB.

Duodenal switch in revisional bariatric surgery: conclusions from an expert consensus panel

“…In a systematic review of 48 studies and 1,565 patients undergoing bariatric procedures, BPD/DS was associated with 73% excess body weight loss (EBWL) at 2 years, ahead of RYGB (63%), gastroplasty (56%), and laparoscopic adjustable gastric banding (LAGB) (49%) (8,a) . These results have been replicated in patients with BMI ≥ 50, where BPD/DS was superior to RYGB in maximizing weight loss up to 9 years following surgery (4,9,10,11) .…”

Surgery in Patients with Super Obesity: Medium‐Term Follow‐Up Outcomes at a High‐Volume Center

“…However, some authors have reported that only 50% to 60% of patients with super obesity who undergo RYGB achieve %EBWL ≥ 50% and that less than 50% maintain BMI < 40 at long-term follow-up (25,26). On the other hand, hypoabsorptive procedures, such as BPD-DS, have shown excellent results in patients with super obesity, with %EBMIL ~80% and 14% to 25% remaining with BMI ≥ 35 (8,27). This is consistent with what we found in our study, in which 22.2% of BRYGB, 9.9% of OAGB, and none of the BSG patients remained with severe obesity at 3 years (BMI ≥ 35).…”

“…At this time, there is a need to determine what procedures are best for patients with super obesity. Some have recommended complex procedures, such as biliopancreatic diversion (BPD) with or without a duodenal switch (BPD‐DS), OAGB, and banded RYGB (BRYGB), while others have recommended a two‐stage procedure with SG as the first stage followed by either RYGB, OAGB, or BPD‐DS . Recently, good to excellent weight loss has been reported with both the banded SG (BSG) and BRYGB in patients with super obesity .…”

Laparoscopic Biliopancreatic Diversion with Duodenal Switch - The Most Effective Operation for Type 2 Diabetes Mellitus. How I do it?

“…The technique of BPD-DS consisting of a a pylorus-preserving gastric sleeve resection with a duodenal switch has been shown to have the best results of any metabolic procedure, including Roux en Y Gastric Bypass, (14) in terms of efficiency and duration of weight loss (3) (Fig. 1).…”