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Duodenal Switch Is Superior to Gastric Bypass in Patients with Super Obesity when Evaluated with the Bariatric Analysis and Reporting Outcome System (BAROS)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.ORCID iD: 0000-0002-6243-2859
2017 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 27, no 9, p. 2308-2316Article in journal (Refereed) Published
Abstract [en]

Background

It is not clear which bariatric procedure that gives the best outcome for patients with super obesity (body mass index [BMI] > 50 kg/m2). This study aims to compare outcomes in patients with super obesity after Roux-en-Y gastric bypass (RYGB) and duodenal switch (BPD/DS) using the Bariatric Analysis and Reporting Outcome System (BAROS) and a local questionnaire for gastrointestinal symptoms.

Methods

A retrospective mail survey including 211 patients, 98 RYGB and 113 BPD/DS, with a mean follow-up time of 4 years for both groups. Gender distribution, age, and comorbidities were similar. Weight loss, changes in comorbidities, quality of life (QoL), and adverse events were registered, as well as gastrointestinal symptoms.

Results

Preoperative BMI was higher in the BPD/DS group (56 ± 6.7 vs. 52 ± 4.0 kg/m2, p < 0.01); despite this, the postoperative BMI was lower (31 ± 5.5 vs. 36 ± 7.1 kg/m2, p < 0.01). The effect on diabetes was superior after BPD/DS; otherwise, both groups had a similar reduction in comorbidities. There was no difference in QoL. Adverse events were less common after RYGB (14 vs. 27%). Overall, the BPD/DS group had a superior BAROS score (4.7 ± 2.0 vs. 4.0 ± 2.1, p < 0.05). Dumping was more common after RYGB (p < 0.01), while reflux, diarrhea, fecal incontinence, and problems with malodorous flatus were more common after BPD/DS (all p < 0.05). Frequency of nausea/vomiting and abdominal pain were similar.

Conclusion

Patients with super obesity have a better weight reduction and metabolic control with BPD/DS, at the cost of higher incidence of adverse events, compared to patients operated with RYGB.

Place, publisher, year, edition, pages
2017. Vol. 27, no 9, p. 2308-2316
Keywords [en]
BAROS, Bariatric surgery, Duodenal switch, Gastric bypass, Quality of life
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-333269DOI: 10.1007/s11695-017-2680-zISI: 000407971600013PubMedID: 28439748OAI: oai:DiVA.org:uu-333269DiVA, id: diva2:1155789
Available from: 2017-11-09 Created: 2017-11-09 Last updated: 2019-02-25Bibliographically approved
In thesis
1. Bariatric Surgery: Outcomes after Gastric Bypass and Duodenal Switch
Open this publication in new window or tab >>Bariatric Surgery: Outcomes after Gastric Bypass and Duodenal Switch
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Obesity is associated with increased morbidity and mortality. A BMI >40 kg/mshortens life expectancy by about 10 years. The obesity related comorbidities diabetes, hypertension, dyslipidemia and sleep apnea contributes to the increased risk of cardiovascular events. There is also an increased risk of some forms of cancer (e.g. colon, breast, and prostate cancer) as well as mental illness (depression and low self-esteem). Bariatric surgery is indicated for those with a BMI >35 kg/m2. Unfortunately, there are an increasing number of patients seeking bariatric surgery who are super obese (BMI >50 kg/m2), a condition more difficult to treat because of insufficient weight loss with standard operations, like the Roux-en-Y Gastric Bypass (RYGB). Therefore some surgeons advocate the Duodenal Switch (DS) in super obese patients, because DS results in greater and more sustained weight loss. However, DS is a technically more challenging operation and is associated with an increased risk of malnutrition and surgical complications. There are also concerns about an excessive loss of fat-free mass during weight loss after RYGB and especially after DS.

This thesis focuses on weight-loss, effect on comorbidities, quality of life and complications after DS and RYGB, respectively, with comparisons between the two procedures in patients with super obesity. 

DS resulted in a superior weight loss compared to RYGB (paper I, II and III) and body composition after weight loss did not differ compared with non-operated controls with the same BMI after surgery, for neither DS nor RYGB (paper I). Both DS and RYGB resulted in an improved metabolic control (paper II and III), but the effect on diabetes and hypertension was greater and maintained in the long-term after DS (paper III). Both DS and RYGB resulted in an improved physical quality of life, with greater improvements after DS (paper III). However, complications and long-term adverse effects were more common after DS (paper II and IV).

In conclusion, the superior weight loss and greater improvements in several obesity-related comorbidities after DS must be weighed against the increased risk of complications and long-term adverse effects compared to RYGB. 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. p. 76
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1550
Keywords
Body composition, fat-free mass, resting metabolic rate, bariatric surgery, obesity, Roux-en-Y Gastric Bypass, Duodenal Switch, air-displacement plethysmography, Bod Pod, indirect calorimetry assessment, BAROS, quality of life, weight loss, diabetes, hypertension, dyslipidmia, depression, pain, antidepressants, opioids, complications, healthcare consumption, adverse events
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-377036 (URN)978-91-513-0593-6 (ISBN)
Public defence
2019-05-17, Grönwallsalen, Ingång 70, BV, Akademiska sjukhuset, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2019-04-18 Created: 2019-02-25 Last updated: 2019-06-18

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Skogar, MartinSundbom, Magnus

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