Bariatric Surgery: Gastric Bypass vs. Duodenal Switch
Duodenal switch patients lost more weight but experienced more adverse effects.
Gastric bypass and biliopancreatic diversion with duodenal switch are two types of bariatric surgery; however, little data exist to compare outcomes of these procedures. In this study from Norway and Sweden, 60 patients with body-mass indexes (BMIs) of 50–60 kg/m2 were randomized to gastric bypass or duodenal switch.
At 2 years, mean weight loss was greater among duodenal switch patients than among gastric bypass patients (74 vs. 51 kg). Total cholesterol levels fell by a mean of 41 mg/dL among duodenal switch patients, but no significant decline was seen among gastric bypass patients. Both groups had significant mean reductions in LDL cholesterol levels (duodenal switch, 30 mg/dL; gastric bypass, 10 mg/dL), systolic blood pressure, diastolic blood pressure, and fasting glucose levels. Rates of adverse events after surgery were significantly higher among duodenal switch patients (62% vs. 32%); these events included hospital readmission, new surgical procedures, cholelithiasis, nutritional deficiencies, infections, and hepatic failure. Patients in both groups reported similar improvements in health-related quality of life.
Comment: Patients who underwent duodenal switch (which is uncommon in the U.S.) lost more weight than gastric bypass patients, but they also experienced significantly higher complication rates. An editorialist notes that all bariatric operations can be associated with major complications, and mortality benefits have not been documented rigorously. Hence, bariatric surgery should be reserved primarily for patients in whom serious obesity-related secondary conditions (e.g., diabetes, sleep apnea) would potentially resolve with surgery.
Published in Journal Watch General Medicine October 11, 2011
Søvik TT et al. Weight loss, cardiovascular risk factors, and quality of life after gastric bypass and duodenal switch: A randomized trial. Ann Intern Med 2011 Sep 6; 155:281. (http://www.annals.org/content/155/5/281.full)
Livingston EH. Primum non nocere. Ann Intern Med 2011 Sep 6; 155:329. (http://www.annals.org/content/155/5/329.full)