Original article
Weight loss is more sustained after biliopancreatic diversion with duodenal switch than Roux-en-Y gastric bypass in superobese patients

https://doi.org/10.1016/j.soard.2012.02.006Get rights and content

Abstract

Background

Although biliopancreatic diversion with duodenal switch (BPD-DS) is not the most performed procedure, Roux-en-Y gastric bypass (RYGB) is challenged by weight regain and insufficient weight loss, especially in patients with a body mass index >50 kg/m2. The aim of our retrospective study was to compare the weight loss after 2 types of primary bariatric surgery. A total of 83 BPD-DS and 97 RYGB procedures were performed from March 2002 to October 2009 for an initial mean body mass index of 55 kg/m2.

Methods

All RYGB patients underwent surgery at a private practice hospital and BPD-DS patients underwent surgery at a university hospital before February 2007 and at the same private hospital thereafter. The patients were seen in follow-up every 4 months the first year, every 6 months the second, and yearly thereafter. The maximum weight loss was assessed, as well as the weight regain beyond the first postoperative year. Weight loss success was defined as a percentage of excess weight loss (%EWL) of ≥50%.

Results

The patients did not differ by age, gender, or length of follow-up (mean 46 mo, range .5–102 for RYGB and 44.3 mo, range 9–111 for BPD-DS). Of the patients, 17 RYGB and 7 BPD-DS patients were lost to follow-up within 3 years postoperatively. At 3 years of follow-up, the mean %EWL was 63.7% ± 17.0% after RYGB and 84.0% ± 14.5% after BPD-DS (P < .0001). Weight loss success was achieved by 83.5% of the RYGB and 98.7% of the BPD-DS patients (P = .0005).

Conclusion

After 12 months postoperatively, the number of patients regaining 10% of the weight lost during the first postoperative year was significantly greater after RYGB than after BPD-DS.

Section snippets

Methods

All consecutive superobese patients, defined by a BMI of ≥50 kg/m2, who had undergone primary, single-stage RYGB or BPD-DS were retrospectively reviewed. Of the 180 patients, 97 had undergone RYGB and 83, BPD-DS. The choice of procedure was determined by 1 of the 2 surgeons involved (G.B., P.T.), with each surgeon performing only 1 type of procedure.

RYGB included a 30-cm3 vertical gastric pouch fashioned by a 60-mm endoscopic linear stapler with blue staple loads. A 150-cm alimentary limb was

Results

All the patients in the RYGB group underwent a laparoscopic procedure without conversion. However, 14 of the BPD-DS cases required the open approach (9 converted from initial laparoscopy). In addition, 6 patients initially scheduled for BPD-DS received only sleeve gastrectomy and were not included in the present study. One BPD-DS patient (BMI 80 kg/m2) who died postoperatively of rhabdomyolysis was also excluded from the present study. This patient had undergone a 5-hour open BPD-DS procedure

Discussion

Although bariatric surgery in the superobese does not seem to be significantly more dangerous than in the morbidly obese population [5], [6], [7], [8], a BMI >50 kg/m2 is usually associated with poorer weight loss results, not only after RYGB [9], [10], [11], [12], but also after BPD-DS [13]. The reasons for this are still unclear: obesity could involve different mechanisms for these extreme weights, and the surgical procedure might encounter technical difficulties, especially when creating a

Conclusion

It is not possible to clearly define the mechanisms of weight regain that affects all bariatric procedures. Superobesity remains a challenge, because weight regain appears to be greater for this population. Despite a lack of difference in the 3-year remission of co-morbidities, BPD-DS not only provided a greater %EWL at the nadir, but had fewer weight loss failures and seemed to be less affected by the weight regain phenomenon. Although responsible for a greater rate of postoperative

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