bariatric procedure resulted in better control of weight and comorbidities than the gold standard gastric bypass, researchers reported.
But that comes at the cost of higher early risks, including infection and the need for re-operation, according to Matthew Martin, MD, and colleagues at Madigan Army Medical Center in Ft. Lewis, Wash.
Nonetheless, Martin and colleagues concluded in the September issue of Archives of Surgery, the biliopancreatic diversion with duodenal switch (dubbed DS) may be a useful alternative to gastric bypass, especially in super-obese patients.
While the Roux-en-Y gastric bypass is widely regarded as the gold standard – and is the most commonly performed bariatric surgery – there is growing evidence that weight loss failure and weight regain may be more common than previously thought.
To evaluate the procedure against the duodenal switch, Martin and colleagues looked at data from the Bariatric Outcomes Longitudinal Database from 2007 to 2010.
During that period, 1,545 patients had DS and 77,406 a gastric bypass, with average preoperative body mass indices of 52 and 48, respectively. Among the 3 percent of patients in each cohort with complete 2-year follow-up data, the average BMI was 31 in the gastric bypass patients and 30 in the DS group.
The primary goals of the analysis were to compare weight loss, control of comorbidities — diabetes, hypertension, and sleep apnea – and weight loss failure, defined as not losing at least 50 percent of the excess pre-op body weight.
Martin and colleagues found that:
Patients undergoing DS had longer operative times (191 versus 114 minutes), greater blood loss, and longer hospital stays (2.4 versus 4.4 days) compared with those having gastric bypass.
3.3 percent of those in the DS group had an early reoperation compared with 1.5 percent of gastric bypass patients.
The percent change in BMI was significantly greater in the DS group at all times during follow-up, reaching 43 percent and 36 percent, respectively, at 2 years.
Among patients with a pre-op BMI of 50 or higher, excess body weight loss at 2 years was 79 percent in the DS group and 67 percent in the gastric bypass group.
Control of diabetes, hypertension, and sleep apnea was significantly better with the DS procedure.
Overall, about 20 percent of bypass patients failed to lose at least 50 percent of their excess BMI at the 1- and 2-year follow-up. The comparable rates for DS were 9 percent and 6 percent, respectively. The advantage for DS was greater in those with a pre-op BMI of 50 or higher.
The DS procedure, while gaining in popularity, remains relatively uncommon, the researchers noted, probably because of concern over technical difficulties and potential long-term nutritional complications.
For that reason, they concluded, "further studies of this procedure to determine the optimal patient selection, operative technique, and longer-term risks versus outcomes are warranted."
The analysis is "well researched and well presented," commented Alec Beekley MD, of Thomas Jefferson University Hospitals in Philadelphia, in an accompanying invited critique.
But it's too early for "full-throated endorsement" of biliopancreatic diversion and duodenal switch, he wrote, largely because the data remain immature. He pointed out that just 3 percent of each cohort had complete 2-year follow-up data.
Nonetheless, Beekley argued, the report is timely and the "findings and conclusions challenge the notion that (gastric bypass) is the optimal operation for the majority of patients."