Long-term Follow-up 15 Years After Duodenal Switch or Gastric Bypass for Super Obesity: a Randomized Controlled Trial

Background In super obesity, Roux-en-Y gastric bypass (RYGB) may be insufficient why some surgeons advocate biliopancreatic diversion with duodenal switch (BPD/DS), a more malabsorptive procedure. There is a paucity of evidence regarding results beyond 10 years, especially after BPD/DS. The aim of t...

Full description

Saved in:
Bibliographic Details
Published in:Obesity surgery 2023-10, Vol.33 (10), p.2981-2990
Main Authors: Möller, Filip, Hedberg, Jakob, Skogar, Martin, Sundbom, Magnus
Format: Article
Language:English
Subjects:
Bariatric surgery
BAROS
Biliopancreatic diversion with duodenal switch
Body mass index
Clinical trials
Diabetes mellitus
Gastrointestinal surgery
Hemoglobin
Long-term results
Medicine
Medicine & Public Health
Obesity
Original Contributions
Roux-en-Y gastric bypass
Surgery
Weight control
Weight loss
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background In super obesity, Roux-en-Y gastric bypass (RYGB) may be insufficient why some surgeons advocate biliopancreatic diversion with duodenal switch (BPD/DS), a more malabsorptive procedure. There is a paucity of evidence regarding results beyond 10 years, especially after BPD/DS. The aim of this randomized controlled trial was to compare the long-term outcome of BPD/DS, and RYGB in patients with super obesity, i.e., body mass index (BMI) > 50 kg/m 2 . Methods This is a 13- to 17-year follow-up study of a single-center, single-blinded randomized trial in which 47 patients (BMI > 48 and eligible for bariatric surgery) were randomized 1:1 to BPD/DS and RYGB (25 men, 24 BPD/DS, 39.1 ± 9.9 years, BMI 54.5 ± 6.1 kg/m 2 ). The primary outcome was weight loss. The study was financed by Swedish governmental funding of clinical research (ALF). Trial registration number: ISRCTN10940791. Results Thirty-four (18 BPD/DS) of the living 42 patients (81.0%) participated. BPD/DS resulted in higher BMI loss (20.4 ± 7.9 vs. 12.4 ± 8.6, p  = .008) and higher percent of total body weight loss (37.5% ± 12.2 vs. 22.8% ± 14.8, p  = .004). BPD/DS was associated with lower fasting glucose, glycated hemoglobin (HbA1c), and low-density lipoprotein (LDL) as well as lower hemoglobin. Adverse events were more common after BPD/DS (2.7 vs. 0.9 per patient, p  = .004). The global assessment tool BAROS (Bariatric Analysis and Reporting Outcome System) demonstrated superior scores for BPD/DS ( p  = .047). Conclusion When compared to RYGB, BPD/DS results in superior weight loss and metabolic control as well as superior BAROS score, however, at the cost of more adverse events. Graphical Abstract
ISSN:0960-8923
1708-0428
1708-0428
DOI:10.1007/s11695-023-06767-0