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Arch Surg. 2012 Sep;147(9):847-54. doi: 10.1001/archsurg.2012.1654.

Analysis of obesity-related outcomes and bariatric failure rates with the duodenal switch vs gastric bypass for morbid obesity.

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  • 1Department of Surgery, Madigan Army Medical Center, Ft Lewis, WA 98431, USA.

Abstract

OBJECTIVE:

To compare the outcomes of a large cohort undergoing biliopancreatic diversion/duodenal switch (DS) vs gastric bypass (GB).

DESIGN:

Retrospective review of the Bariatric Outcomes Longitudinal Database from 2007 to 2010. All inpatient and outpatient follow-up data were analyzed.

SETTING:

Multicenter database.

PATIENTS:

Patients undergoing primary DS were compared with a concurrent cohort undergoing GB.

MAIN OUTCOME MEASURES:

The main outcome measures were (1) weight loss; (2) control of comorbidities including diabetes mellitus, hypertension, and sleep apnea; and (3) failure to achieve at least 50% excess body weight loss.

RESULTS:

One thousand five hundred forty-five patients underwent DS and 77 406 underwent GB, with a mean preoperative body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 52 and 48, respectively (P < .01). The DS was associated with longer operative times, greater blood loss, and longer lengths of hospital stay (all P < .05). Early reoperation rates were higher in the DS group (3.3% vs 1.5%). Percentage of change in BMI was significantly greater in the DS group at all follow-up intervals (P < .05). Subgroup analysis of the superobese population (BMI >50) revealed significantly greater percentage of excess body weight loss in the DS group at 2 years (79% vs 67%; P < .01). Comorbidity control of diabetes, hypertension, and sleep apnea were all superior with the DS (all P < .05). The risk of weight loss failure was significantly reduced with DS vs GB for all patients, with a greater reduction in the BMI more than 50 subgroup.

CONCLUSIONS:

The DS is a less commonly used bariatric operation, with higher early risks compared with GB. However, the DS achieved better weight and comorbidity control, with even more pronounced benefits among the superobese.

Comment in

PMID:
22987179
[PubMed - indexed for MEDLINE]
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