American Surgical Association
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Duodenal Switch Provides Superior Weight Loss in the Super-obese (BMI ≥ 50) Compared to Gastric Bypass
Vivek N. Prachand, M.D.*, Roy T. DaVee, BS*, John C. Alverdy, M.D.
University of Chicago, Chicago, IL

OBJECTIVE(S): Although weight loss following Roux-en-Y gastric bypass is acceptable in patients with BMI’s between 35 and 50 kg/m2, failure rates approach 40% in several series of patients with BMI of ≥ 50 kg/m2. Here we report the first large single institution series directly comparing weight-loss outcomes in super-obese patients following biliopancreatic diversion with duodenal switch (DS) and Roux-en-Y Gastric Bypass (RY).
METHODS: All super-obese patients (BMI ≥ 50 kg/m2) undergoing standardized laparoscopic and open DS and RY between 08/02 and 10/05 were identified from a prospective database. Two-sample t-tests were used to compare weight loss, decrease in BMI, and percentage of excess body weight loss (%EBWL) after surgery. Chi-square analysis was used to determine the rate of successful weight loss, defined as achieving at least 50% loss of excess body weight.
RESULTS: 318 super-obese patients underwent DS (n=185) or RY (n=133) with equal 30-day mortality (DS:1/185, RY:0/133 p=ns). The % EBWL at follow-up was statistically greater for DS than RY (12 months: 65% vs. 57%; 18 months: 73% vs. 63% (p<0.05)). Total weight loss and decrease in BMI were also statistically greater for the DS (data not shown). Importantly, the likelihood of successful weight loss (EBWL > 50%) was significantly greater in patients following DS (12 months: 88.3% vs. 70.0%; 18 months: 93% vs. 70.6% (p<0.05)). Follow-up at 24 months demonstrated persistence of these trends.
CONCLUSIONS: Direct comparison of DS to RY demonstrates superior weight loss outcomes for DS. DS may be the surgical treatment of choice for super-obesity.

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