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