The duodenal switch weight loss procedure produced greater weight loss results in severely obese patients compared to gastric bypass surgery, according to a study recently published online in Surgery for Obesity and Related Diseases.
A severely obese person is someone whose body mass index (BMI) is 40 or more. This is about 100 pounds overweight for an average man or 80 pounds overweight for an average woman.
Not only is severe obesity considered a serious health threat, but it is a very difficult disease to treat. Even the touted Roux-en-Y gastric bypass surgery can have inferior weight loss results in super obese patients, as mentioned by the researchers in their article.
This study adds to previous evidence that the duodenal switch produces superior weight loss results, significant improvements in obesity comorbidities, and high satisfaction rates in the super obese population.
Although the duodenal switch is the most drastic weight loss procedure commonly offered, it is an acceptable alternative for patients with severe obesity. The duodenal switch promotes weight loss by food restriction (via vertical sleeve gastrectomy – reduction of the stomach volume) and calorie absorption (via duodenal switch – intestinal bypass).
The study “Superior weight loss and lower HbA1c three years after duodenal switch compared to Roux-en-Y gastric bypass – a randomized controlled trial” took place at Uppsala University, Sweden. The objective of this study was to compare the biliopancreatic diversion with duodenal switch (BPD/DS) and Roux-en-Y gastric bypass (RYGB) in patients with a body mass index (BMI) of 48 or more as to issues of safety, weight loss, and postoperative symptoms.
The controlled trial involved 47 patients (22 women, 25 men) with an average BMI of 54. The patients were randomized to duodenal switch (24 patients) and gastric bypass (23 patients). Biochemical data was collected before surgery and at one and three years after surgery; a questionnaire pertaining to weight, general satisfaction, and gastrointestinal symptoms was distributed about four years after surgery.
The following results were observed in study participants:
- Both procedures were safe and yielded high satisfaction rates
- Duration of surgery was longer with BPD/DS than RYGB (157 vs 117 minutes)
- Postoperative morphine consumption was higher after BPD/DS than RYGB (140 vs 93 mg)
- Excess BMI loss was greater after BPD/DS than RYGB (80% +/- 15% vs 51% +/- 23%)
- Glucose and glycated hemoglobine levels were lower after BPD/DS at three years
In response to the follow-up questionnaire, more patients listed troublesome diarrhea and malodorous flatus after BPD/DS, however it was not a significant difference.
Patients who are interested in duodenal switch weight loss surgery will find that few surgeons perform this procedure. It is a technically challenging operation and only about 50 surgeons worldwide have the experience or expertise to offer it to their patients.
The advantages of duodenal switch include: high rate of excess weight loss and improvement in obesity comorbidities, better eating quality, no dumping syndrome, reduces appetite and hunger, very effective for high BMI patients (BMI greater than 50).
Some of the disadvantages of duodenal switch to consider are: need for lifelong supplementation and monitoring for nutritional deficiencies, some foods may cause intestinal irritation, gas pains, bloating, diarrhea or smelly gas, complex operation offered by few qualified surgeons.
The duodenal switch procedure may seem like a drastic operation to some, but for those who are suffering from severe obesity, it may be a lifesaving weight loss option. Patients who are interested in this procedure should seek an evaluation from an experienced and skillful bariatric surgeon for proper diagnoses and treatment.