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Comparison of Obesity Surgeries Turns Up Surprising Results
Date:9/18/2012

tcomes of more than 77,000 patients who had a traditional gastric bypass and an average body-mass index of 48 with more than 1,500 patients who had a duodenal switch and average body-mass index of 52. Body-mass index (BMI) is a measurement of body fat based on height and weight. A BMI over 40 is considered morbidly obese. More than three-quarters of the patients were women, and their average age was 45.

The duodenal switch procedure takes more than 20 minutes longer to perform on average and is associated with more blood loss and longer hospital stays -- 4.4 days vs. 2.2 days. Nearly all of the gastric bypass patients had laparoscopic surgery, while half of the duodenal switch patients underwent open surgery, which poses a longer recovery time.

The duodenal switch, however, resulted in greater sustained weight loss, the researchers found.

This result was especially noticeable among the most obese patients, called the superobese, the researchers said. Two years after surgery, 79 percent of those who had a duodenal switch still had a significant weight loss compared with 67 percent who had gastric bypass.

In addition, almost 20 percent of patients who had a gastric bypass failed to lose at least 50 percent of their body mass at the two-year follow-up, compared with 6 percent who underwent a duodenal switch, they noted.

Moreover, patients who had a duodenal switch had greater improvement in obesity-related conditions, such as diabetes, high blood pressure, high cholesterol and sleep apnea, the researchers found.

Dr. Mitchell Roslin, chief of obesity surgery at Lenox Hill Hospital in New York City, said patients gain weight after a gastric bypass because they suffer from low sugar and get instantly hungry.

"We do not see that in the duodenal switch nearly as much, because the pyloric valve is preserved," he said. "It is far better to preserve the pyloric valve and do your bypass underneath it, although it's technically more
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