The researchers report that the duodenal switch (DS) produced greater weight loss by all measures in patients with a body mass index (BMI) of at least 50. These patients typically carry at least 150 pounds more than their ideal weight. "While there is no single ideal bariatric procedure that can be applied to all severely obese patients, we have generally recommended the duodenal switch for those with a BMI greater than 50," said study author Vivek Prachand, M.D., assistant professor of surgery at the University of Chicago. "This study confirms that approach."

The study involved 350 consecutive super-obese patients who underwent weight-loss surgery. One hundred ninety-eight patients underwent duodenal switch and 152 had a Roux-en-Y gastric bypass (RYGB). The average age was 40, but that ranged from 18 to 68. About 92 percent had the surgery performed laparoscopically, through small abdominal incisions. 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.

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. 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."

MEDICA.de; Source: University of Chicago