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Superior weight loss and lower HbA1c 3 years after duodenal switch compared with Roux-en-Y gastric bypass: a randomized controlled trial
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery. (Ventrikel-Esofagus)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery. (Ventrikel-Esofagus)
2012 (English)In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 8, no 3, 338-343 p.Article in journal (Refereed) Published
Abstract [en]

Background: Obesity is a rising threat to public health. The relative increase in the incidence of morbid obesity is most pronounced in the most severely obese. Roux-en-Y gastric bypass (RYGB) results in inferior weight loss in this group. Therefore, we have offered biliopancreatic diversion with duodenal switch (BPD/DS) as an alternative for this patient category. Our objective was to compare BPD/DS and RYGB in the surgical treatment of morbid obesity in patients with a body mass index (BMI) >48 kg/m(2). The setting was a university hospital in Sweden.

Methods: In a controlled trial (registration number 1SRCTN10940791), 47 patients (25 men, BMI 54.5 +/- 6.1 kg/m(2)) were randomized to RYGB (n = 23) or BPD/DS (n = 24). Biochemical data were collected preoperatively and 1 and 3 years postoperatively. A questionnaire addressing weight, general satisfaction, and gastrointestinal symptoms was distributed a median of 4 years postoperatively.

Results: Both procedures were safe. The duration of surgery and postoperative morphine consumption were greater after BPD/DS than after RYGB (157 versus 117 min and 140 versus 93 mg, respectively). BPD/DS resulted in greater weight loss than RYGB (-23.2 +/- 4.9 versus 16.2 +/- 6.9 BMI units or 80% +/- 15% versus 51% +/- 23% excess BMI loss, P < .001). BPD/DS yielded lower glucose and glycated hemoglobin levels at 3 years. More patients listed troublesome diarrhea and malodorous flatus in the questionnaire after BPD/DS, but no significant difference was seen (P = .078 and P = .073, respectively).

Conclusions: BPD/DS produced superior weight results and lower glycated hemoglobin levels compared with RYGB in patients with a BMI >48 kg/m(2). Both operations yield high satisfaction rates. However, diarrhea tended to be more common after BPD/DS.

Place, publisher, year, edition, pages
2012. Vol. 8, no 3, 338-343 p.
Keyword [en]
Duodenal switch, Roux-en-Y gastric bypass, Weight loss, Abdominal symptoms, Glucose control
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-131888DOI: 10.1016/j.soard.2012.01.014ISI: 000304520900015OAI: oai:DiVA.org:uu-131888DiVA: diva2:355989
Note
Manuscript title: Superior weight loss and glucose control three years after duodenal switch compared to Roux-en-Y gastric bypassAvailable from: 2010-10-09 Created: 2010-10-09 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Gastrointestinal Physiology and Results following Bariatric Surgery
Open this publication in new window or tab >>Gastrointestinal Physiology and Results following Bariatric Surgery
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The number of operations for morbid obesity is rising fast. We have examined aspects of postoperative physiology and results after bariatric surgery.

The pH in the proximal pouch after Roux-en-Y gastric bypass (RYGBP) was investigated with catheter-based and wire-less technique. Gastric emptying, PYY-levels in the fasting state and after a standardized meal was evaluated after biliopancreatic diversion with duodenal switch (DS). A clinical trial was undertaken, comparing DS to RYGBP in patients with BMI>48. Main outcome variables were safety and long-term weight results as well as abdominal symptoms and laboratory results.

Patients with stomal ulcer had significantly lower pH in their proximal gastric pouch as compared to asymptomatic control subjects. Long-time pH measurements with the wire-less BRAVO-system were feasible and demonstrated pH<4 in median 10.5% of the time in asymptomatic post-RYGBP patients. After DS, the T50 of gastric emptying was 28±16 minutes. PYY-levels were higher after DS than in age-matched control subjects. BMI-reduction was greater after DS (24 BMI-units) than after RYGBP (17 BMI-units) in median 3.5 (2.0-5.3) years after surgery (p<0.001). Fasting glucose and HbA1c levels were lower one and three years after DS as compared to RYGBP. On the other hand, DS-patients reported having more diarrhea and malodorous flatus.

This thesis has resulted in deepened knowledge. Acid produced in the proximal pouch is an important pathogenetic factor in the development of stomal ulcer after RYGBP. However, symptom-free patients have an acidic environment in the proximal Roux-limb as well. After DS, gastric emptying is fast, but not instantaneous, and PYY-levels are high. DS results in superior weight reduction and better glucose control as compared to RYGBP in patients with BMI>48. We believe that DS has a place in surgical treatment of the super-obese, even though symptoms of diarrhea and malodorous flatus are more common after DS.

 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 72 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 607
Keyword
Bariatric surgery, gastric bypass, biliopancreatic diversion with duodenal switch, PYY, stomal ulcer, gastric emptying
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-131889 (URN)978-91-554-7916-9 (ISBN)
Public defence
2010-11-27, Grönwallsalen, Ing 70 Akademiska Sjukhuset, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2010-11-04 Created: 2010-10-09 Last updated: 2011-01-13Bibliographically approved

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Hedberg, JakobSundbom, Magnus

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