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

Abstract

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

Weight Gain After Short- and Long-Limb Gastric Bypass in Patients Followed for Longer Than 10 Years

“…There is still a significant difference when the analysis is performed with n ϭ 69 in the laparoscopic colorectal cancer group, which is the total that we obtained from the data in Table 1 (FGF-2) is another potent angiogenic and growth factor that plays an important role in regulation of tumor growth and wound healing. 4 Its circulating levels have been shown to be increased following surgery 5,6 as well as in patients with primary/metastatic colorectal cancer.…”

“…These results are contradicted by the recent prospective comparison of RYGB versus BPD/DS from the University of Chicago, which showed significantly greater weight loss favoring the duodenal switch 6 months postoperatively. 6 The preponderance of available clinical data shows that adding malabsorption to gastric restriction improves short-term weight loss in bariatric surgical patients. These data include all of the prospective randomized comparisons of purely restrictive operations versus RYGB and the recent comparison of RYGB versus BPD/DS.…”

Rapid Evidence Review of Bariatric Surgery in Super Obesity (BMI ≥ 50 kg/m2)

“…Philosophically, it may be ideal to strive to reduce BMI to a level that would eliminate eligibility for bariatric surgery. 41 But as this is more difficult to achieve in super obese patients, it could be clinically useful to document what level of weight loss is really necessary to achieve the greater overall goals. As the current evidence is very limited in the super obese, we recommended that the HSR&D SOTA committee, in setting their research agenda, prioritize confirmation of the subgroup findings from Arterburn et al about the comparison of bariatric surgery to non-surgical treatment in the super obese.…”

“…27 For the comparison of different bariatric surgery types, data were available from one systematic review, 28 two RCTs, 29,30 and 18 retrospective cohorts. [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] The majority of studies involved mostly women aged 35 to 45 years. We rated the systematic review as fair quality, 28 one RCT (in four studies) as low risk of bias, 29,[49][50][51] and one RCT as unclear risk of bias.…”

Recent advancements in bariatric/metabolic surgery

“…However, SG‐DJB might be a better choice for patients from a gastric cancer endemic area or with a family history of gastric cancer. Patients super‐morbidly obese (BMI >50) may consider a malabsorptive procedure, BPD/DS or LSAGB 111. However, the patients should be notified about the risk of malnutrition and must take supplements.…”