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For Super-Obese Patients, Duodenal Switch Beats Gastric Bypass

eight loss. DS patients lost more total weight and a larger percentage of excess body weight and consequently had a bigger decrease in BMI. When they were weighed one year after surgery, DS patients had lost an average of 149 pounds compared to 121 pounds for RYGB patients. After three years, DS patients had lost 173 pounds, but average weight loss for RYGB patients had decreased to 118 pounds.

“Every one of these patients had significant weight loss,” Prachand said, “but the duodenal-switch patients had greater weight loss and seemed to keep the weight off longer.”

"There has been a perception amongst bariatric surgeons that the duodenal switch might provide better weight loss than gastric bypass in super-obese individuals," said Prachand. Several studies have demonstrated higher rates of weight-loss failure and weight regain following gastric bypass in these patients.

But surgeons have been hesitant to adopt the duodenal switch for several reasons, he said: "greater technical complexity of the operation, particularly when performed laparoscopically; greater potential for nutritional deficiencies; and need for life-long medical follow-up."

"Given these concerns," he said, "it would be difficult to recommend duodenal switch without demonstrating a significant advantage over the gastric bypass, which is generally a very effective operation in severely obese patients. Our study demonstrates an advantage with regards to weight loss.”

"We still need longer-term data on these patients,” he added. “We are currently comparing nutritional outcomes and improvement in obesity-related medical problems, including type 2 diabetes, high blood pressure, elevated cholesterol levels, acid reflux, and obstructive sleep apnea in these patients. We don’t know yet how much weight loss we need to get those health benefits, but losing more of the excess weight certainly seems to be better.”



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