In the Journals

Duodenal switch leads to better metabolic control vs. RYGB

Adults with severe obesity lost more weight and achieved better metabolic control following duodenal switch compared with Roux-en-Y gastric bypass, but duodenal switch was associated with more adverse events, according to study findings.

Martin L. Skogar, MD, a resident physician, and Magnus Sundbom, MD, an adjunct professor, both in the department of surgical sciences at Uppsala University in Sweden, evaluated 211 adults (mean age, 40 years) with obesity (BMI > 50 kg/m2) who underwent Roux-en-Y gastric bypass (RYGB; n = 98) or duodenal switch (n = 113) surgery to determine the outcomes of each procedure. The Bariatric Analysis and Reporting Outcome System (BAROS) was used to evaluate outcomes of each group, and participants also completed a questionnaire to report on gastrointestinal symptoms. Mean follow-up time was 4 years.

The percent excess BMI loss was greater in the duodenal switch group (79%) compared with the RYGB group (62%; P < .01). After weight loss, 49% in the RYGB group and 24% in the duodenal switch group remained severely obese (BMI > 35 kg/m2).

Obesity-related comorbidities were noted in the medical records of 62% of the RYGB group and 58% of the duodenal switch group before surgery. After surgery, both groups experienced significant reductions in diabetes and sleep apnea (P < .05 for all); a significant reduction in dyslipidemia also occurred in the duodenal switch group (P < .01).

One or more complications were reported by 14% of participants in the RYGB group and 27% of participants in the duodenal switch group. The RYGB group had a lower overall complication rate compared with the duodenal switch group (P > .05).

The RYGB group scored higher in the weight-loss category compared with the duodenal switch group, whereas results were similar for comorbidities and quality of life. However, the duodenal switch group had a higher BAROS score compared with the RYGB group. More participants in the duodenal switch group reported their outcomes as “excellent” (27% vs. 13% for RYGB) and fewer reported their outcomes as a “failure” (4% vs. 8%) or “fair” (8% vs. 17%) compared with the RYGB group.

The RYGB group was more likely to experience symptoms of gastric emptying compared with the duodenal switch group (P < .01), whereas the duodenal switch group experienced gastroesophageal reflux, diarrhea, fecal incontinence and problems with malodorous flatus (P < .05 for all).

Overall perception of outcomes after surgery was similar between the RYGB group (58%) and duodenal switch group (62%), and 90% of participants in both groups would recommend the surgery to other adults with severe obesity.

“Patients with super obesity have superior weight reduction and a better effect on diabetes with [duodenal switch],” the researchers wrote. “This occurs at the cost of more adverse events and [gastrointestinal] symptoms, but with similar [quality of life], compared to patients operated with RYGB. We therefore believe that the choice of bariatric procedure must be made in close agreement between the surgeon and a well-informed patient.” – by Amber Cox

Disclosure: The researchers report no relevant financial disclosures.

Adults with severe obesity lost more weight and achieved better metabolic control following duodenal switch compared with Roux-en-Y gastric bypass, but duodenal switch was associated with more adverse events, according to study findings.

Martin L. Skogar, MD, a resident physician, and Magnus Sundbom, MD, an adjunct professor, both in the department of surgical sciences at Uppsala University in Sweden, evaluated 211 adults (mean age, 40 years) with obesity (BMI > 50 kg/m2) who underwent Roux-en-Y gastric bypass (RYGB; n = 98) or duodenal switch (n = 113) surgery to determine the outcomes of each procedure. The Bariatric Analysis and Reporting Outcome System (BAROS) was used to evaluate outcomes of each group, and participants also completed a questionnaire to report on gastrointestinal symptoms. Mean follow-up time was 4 years.

The percent excess BMI loss was greater in the duodenal switch group (79%) compared with the RYGB group (62%; P < .01). After weight loss, 49% in the RYGB group and 24% in the duodenal switch group remained severely obese (BMI > 35 kg/m2).

Obesity-related comorbidities were noted in the medical records of 62% of the RYGB group and 58% of the duodenal switch group before surgery. After surgery, both groups experienced significant reductions in diabetes and sleep apnea (P < .05 for all); a significant reduction in dyslipidemia also occurred in the duodenal switch group (P < .01).

One or more complications were reported by 14% of participants in the RYGB group and 27% of participants in the duodenal switch group. The RYGB group had a lower overall complication rate compared with the duodenal switch group (P > .05).

The RYGB group scored higher in the weight-loss category compared with the duodenal switch group, whereas results were similar for comorbidities and quality of life. However, the duodenal switch group had a higher BAROS score compared with the RYGB group. More participants in the duodenal switch group reported their outcomes as “excellent” (27% vs. 13% for RYGB) and fewer reported their outcomes as a “failure” (4% vs. 8%) or “fair” (8% vs. 17%) compared with the RYGB group.

The RYGB group was more likely to experience symptoms of gastric emptying compared with the duodenal switch group (P < .01), whereas the duodenal switch group experienced gastroesophageal reflux, diarrhea, fecal incontinence and problems with malodorous flatus (P < .05 for all).

Overall perception of outcomes after surgery was similar between the RYGB group (58%) and duodenal switch group (62%), and 90% of participants in both groups would recommend the surgery to other adults with severe obesity.

“Patients with super obesity have superior weight reduction and a better effect on diabetes with [duodenal switch],” the researchers wrote. “This occurs at the cost of more adverse events and [gastrointestinal] symptoms, but with similar [quality of life], compared to patients operated with RYGB. We therefore believe that the choice of bariatric procedure must be made in close agreement between the surgeon and a well-informed patient.” – by Amber Cox

Disclosure: The researchers report no relevant financial disclosures.