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Objectives: Although Roux-en-Y gastric bypass (RYGB) is the most common bariatric operation performed in the U.S., recent data suggest inadequate weight loss rates approaching 40% in super-obese patients (BMI >50 kg/m2). We previously reported the first large single institution series directly comparing the short-term weight-loss outcomes in super-obese patients following biliopancreatic diversion with duodenal switch (DS) and RYGB up to 3 years following the operation. Here we report an intermediate-term analysis of this comparison up to 8 years after surgery.
Methods: All super-obese patients undergoing DS or RYGB between August 2002 to October 2005 were identified from a prospective database. Two sample t-tests were used to compare weight loss, decrease in BMI, and excess body weight loss (EBWL) after surgery. Chi-squared analysis was used to determine the rate of successful weight loss (EBWL > 50%) at all time points.
Results: 350 super-obese patients [DS(n=198), RYGB (n=152) were identified. There was an equal 30 day mortality between the two groups (DS, 1 of 198; RYGB, 0 of 152; P not significant). A total of 6 additional patients were excluded from the analysis (5 DS patients underwent revision due to nutritional issues, 1 RYGB was converted to DS for insufficient weight loss). There was a significantly lower BMI following the DS procedure compared to the RYGB at all time points (4yr, 33 vs. 39; 5-6yr 33 vs39; yr7-8, 36vs 41). Total weight loss and %EBWL were also statistically greater for the DS. In addition, the likelihood to achieve successful weight loss (EBWL > 50%) is significantly greater following the DS at all time points (4yr, 83% vs. 56%; 5-6yr 86% vs48%; yr7-8, 68%vs 22%).
Conclusions: DS has superior intermediate-term weight loss outcomes in the super-obese compared to the RYGB.