Featured Research

from universities, journals, and other organizations

Study compares duodenal switch vs. gastric bypass for morbid obesity

Date:
September 17, 2012
Source:
JAMA and Archives Journals
Summary:
A study comparing bariatric surgical procedures for obesity suggests that even though undergoing the less commonly used biliopancreatic diversion/duodenal switch (DS) may be associated with higher early risks compared with gastric bypass, the DS appears to achieve better weight loss and control of co-existing illnesses, especially among patients whose body mass index was more than 50.

A study comparing bariatric surgical procedures for obesity suggests that even though undergoing the less commonly used biliopancreatic diversion/duodenal switch (DS) may be associated with higher early risks compared with gastric bypass (GB), the DS appears to achieve better weight loss and control of co-existing illnesses, especially among patients whose body mass index (BMI) was more than 50, according to a report in the September issue of Archives of Surgery, a JAMA Network publication.

Bariatric surgery has been established as the most effective way to treat morbid obesity and weight-related co-existing illnesses. The traditional Roux-en-Y gastric bypass (GB) is widely considered "the gold standard," but some evidence suggests that weight loss failure and weight regain may be more prevalent than first thought, especially among the "superobese" (BMI greater than 50), the authors write in the study background.

Daniel W. Nelson, D.O., and colleagues from the Madigan Army Medical Center, Fort Lewis, Washington, used the Bariatric Outcomes Longitudinal Database (BOLD) to compare 1,545 patients who underwent DS (average preoperative BMI of 52) with 77,406 patients who underwent GB (average preoperative BMI of 48) between 2007 and 2010. The average age of the patients was 45 years and 78 percent of the patients were female.

"Although the DS carries a higher relative risk profile than GB, the absolute risk is low. Among morbidly obese patients, the DS results in superior sustained weight reduction and improved comorbidity control compared with GB, which may outweigh early perioperative risk. The benefits of the DS, including a significant decrease in the bariatric failure rates, appear to be greatest in the superobese population," the authors comment.

While the DS was associated with longer operative times (191 vs. 114 minutes), greater estimated blood loss and longer hospital stays (2.4 vs. 4.4 days), the percentage of change in BMI was significantly greater in the DS group at all follow-up intervals. In the superobese population, the DS was associated with a significantly greater percentage of excess body weight loss at two years of follow-up compared to GB (79 percent vs. 67 percent), according to the study results. The results also indicate that nearly 20 percent of GB patients failed to lose at least 50 percent of their excess BMI by both the one- and two-year follow-ups, while the weight loss failure rates for DS patients were lower at 9 percent and 6 percent.

"Finally, in regard to postoperative comorbidity control, the DS group saw significantly greater resolution or improvement in most of the well-recognized obesity-related comorbidities, including diabetes, hypertension, hyperlipidemia [high cholesterol] and obstructive sleep apnea," according to the results.

Although researchers note a relative increase in the use of the DS, this procedure is still used much less in theUnited Statescompared with gastric bypass. The researchers suggest that is likely due to several factors, including the technical difficulty of the procedure, the higher reported rates of short-term complications and concerns about the longer-term nutritional consequences of a primarily malabsorptive procedure (where absorption of calories and nutrients is reduced).

"Further studies of this procedure to determine the optimal patient selection, operative technique and longer-term risks vs. outcomes are warranted," the authors conclude.

Invited Critique: Time for a Change in Gastric Bypass?

In an invited critique, Alec C. Beekley, M.D., of the Thomas Jefferson University Hospitals,Philadelphia, writes: "In summary, Nelson and colleagues provide a well-researched and well-presented analysis of DS [biliopancreatic diversion/duodenal switch] vs. GB [gastric bypass] for morbid obesity, derived from an enormous and reliable database."

"Their findings and conclusions challenge the notion that GB is the optimal operation for the majority of patients. As more surgeons familiarize themselves with the operative techniques and follow-up requirements for DS patients, it may be used more frequently in the superobese population," Beekley concludes.


Story Source:

The above story is based on materials provided by JAMA and Archives Journals. Note: Materials may be edited for content and length.


Journal References:

  1. Nelson DW, Blair KS, Martin MJ. Analysis of Obesity-Related Outcomes and Bariatric Failure Rates With the Duodenal Switch vs Gastric Bypass for Morbid Obesity. Archives of Surgery, 2012; 147 (9): 847-854 DOI: 10.1001/archsurg.2012.1654
  2. Beekley AC. Gastric Bypass: Time for a Change? Archives of Surgery, 2012; 147 (9): 854-855 DOI: 10.1001/archsurg.2012.1682

Cite This Page:

JAMA and Archives Journals. "Study compares duodenal switch vs. gastric bypass for morbid obesity." ScienceDaily. ScienceDaily, 17 September 2012. <www.sciencedaily.com/releases/2012/09/120917161416.htm>.
JAMA and Archives Journals. (2012, September 17). Study compares duodenal switch vs. gastric bypass for morbid obesity. ScienceDaily. Retrieved August 21, 2014 from www.sciencedaily.com/releases/2012/09/120917161416.htm
JAMA and Archives Journals. "Study compares duodenal switch vs. gastric bypass for morbid obesity." ScienceDaily. www.sciencedaily.com/releases/2012/09/120917161416.htm (accessed August 21, 2014).

Share This




More Health & Medicine News

Thursday, August 21, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Drug Used To Treat 'Ebola's Cousin' Shows Promise

Drug Used To Treat 'Ebola's Cousin' Shows Promise

Newsy (Aug. 21, 2014) An experimental drug used to treat Marburg virus in rhesus monkeys could give new insight into a similar treatment for Ebola. Video provided by Newsy
Powered by NewsLook.com
Cadavers, a Teen, and a Medical School Dream

Cadavers, a Teen, and a Medical School Dream

AP (Aug. 21, 2014) Contains graphic content. He's only 17. But Johntrell Bowles has wanted to be a doctor from a young age, despite the odds against him. He was recently the youngest participant in a cadaver program at the Indiana University NW medical school. (Aug. 21) Video provided by AP
Powered by NewsLook.com
American Ebola Patients Released: What Cured Them?

American Ebola Patients Released: What Cured Them?

Newsy (Aug. 21, 2014) It's unclear whether the American Ebola patients' recoveries can be attributed to an experimental drug or early detection and good medical care. Video provided by Newsy
Powered by NewsLook.com
Lost Brain Cells To Blame For Sleep Problems Among Seniors

Lost Brain Cells To Blame For Sleep Problems Among Seniors

Newsy (Aug. 21, 2014) According to a new study, elderly people might have trouble sleeping because of the loss of a certain group of neurons in the brain. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins