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For Super-Obese Patients, Duodenal Switch Beats Gastric Bypass

in 2000, which adds up to more then 50,000 people in the U.S.

At the same time, bariatric or weight-loss surgery has increased from about 16,000 cases in 1992, to 63,000 in 2002, to 171,000 in 2005. The most common surgical procedure for these patients—more than 80 percent of all bariatric operations in 2002—is the gastric bypass, which involves stapling off a large portion of the stomach to make overeating difficult, and rerouting the intestines to reduce the absorption of calories. The duodenal switch—fewer than eight percent of all bariatric procedures performed nationwide—leaves a slightly larger stomach pouch but makes even more drastic alterations to the intestines to limit absorption, particularly of fats and starches.

This study involved 350 consecutive super-obese patients who underwent weight-loss surgery at the University of Chicago Hospitals between Aug. 5, 2002, and Nov. 10, 2005. One hundred ninety-eight patients underwent duodenal switch and 152 had a gastric bypass. More than 80 percent of both groups were female. The average age was 40, but that ranged from 18 to 68. About 92 percent had the surgery performed laparoscopically, through small abdominal incisions.

The duodenal-switch patients were slightly heavier. Their average weight before surgery was 368 pounds, compared to 346 for gastric-bypass patients. Average BMIs were also higher: 58.8 for the duodenal-switch patients (up to 96.3), compared to an average BMI of 56.4 for gastric-bypass patients (up to 84.2).

On average, patients who had a duodenal switch stayed in the hospital one day longer, four days instead of three. About 24 percent of DS patients stayed more than four days and about 20 percent of RYGB patients stayed more than three days. There was one death among the 198 duodenal-switch patients within 30 days of the operation and no deaths before 30 days among 152 gastric-bypass patients.

The duodenal switch produced greater w
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