Laparoscopic duodenal switch resulted in a significantly greater mean reduction in body mass index at 5 years compared with gastric bypass (mean difference 8.5; 95% CI 4.9-12.2; P<.001).
RCT (n=60)
Open-label
randomly assigned
Yes
Does laparoscopic duodenal switch reduce body mass index in patients with a body mass index of 50 to 60 compared to laparoscopic gastric bypass?
In patients with BMI 50-60, duodenal switch results in greater weight loss and metabolic improvements at 5 years compared to gastric bypass, but at the cost of more surgical, nutritional, and gastrointestinal adverse effects.
Mean Difference: 8.5 (95% CI 4.9–12.2)
Absolute Event Rate: 22.1% vs 13.6%
p-value: p=<.001
IMPORTANCE: There is no consensus as to which bariatric procedure is preferred to reduce weight and improve health in patients with a body mass index higher than 50. OBJECTIVE: To compare 5-year outcomes after Roux-en-Y gastric bypass (gastric bypass) and biliopancreatic diversion with duodenal switch (duodenal switch). DESIGN, SETTING, AND PARTICIPANTS: Randomized clinical open-label trial at Oslo University Hospital, Oslo, Norway, and Sahlgrenska University Hospital, Gothenburg, Sweden. Participants were recruited between March 17, 2006, and August 20, 2007, and included 60 patients aged 20 to 50 years with a body mass index of 50 to 60. The current study provides the 5-year follow-up analyses by intent to treat, excluding one participant accepted for inclusion who declined being operated on prior to knowing to what group he was randomized. INTERVENTIONS: Laparoscopic gastric bypass and laparoscopic duodenal switch. MAIN OUTCOMES AND MEASURES: Body mass index and secondary outcomes including anthropometric measures, cardiometabolic risk factors, pulmonary function, vitamin status, gastrointestinal symptoms, health-related quality of life, and adverse events. RESULTS: Sixty patients were randomly assigned and operated on with gastric bypass (n = 31) and duodenal switch (n = 29). Fifty-five patients (92%) completed the study. Five years after surgery, the mean reductions in body mass index were 13.6 (95% CI, 11.0-16.1) and 22.1 (95% CI, 19.5-24.7) after gastric bypass and duodenal switch, respectively. The mean between-group difference was 8.5 (95% CI, 4.9-12.2; P < .001). Remission rates of type 2 diabetes mellitus and metabolic syndrome and changes in blood pressure and lung function were similar between groups. Reductions in total cholesterol, low-density lipoprotein cholesterol, triglycerides, and fasting glucose were significantly greater after duodenal switch compared with gastric bypass. Serum concentrations of vitamin A and 25-hydroxyvitamin D were significantly reduced after duodenal switch compared with gastric bypass. Duodenal switch was associated with more gastrointestinal adverse effects. Health-related quality of life was similar between groups. Patients with duodenal switch underwent more surgical procedures related to the initial procedure (13 44.8% vs 3 9.7% patients; P = .002) and had significantly more hospital admissions compared with patients with gastric bypass. CONCLUSIONS AND RELEVANCE: In patients with a body mass index of 50 to 60, duodenal switch resulted in greater weight loss and greater improvements in low-density lipoprotein cholesterol, triglyceride, and glucose levels 5 years after surgery compared with gastric bypass while improvements in health-related quality of life were similar. However, duodenal switch was associated with more surgical, nutritional, and gastrointestinal adverse effects. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00327912.
Risstad et al. (Wed,) conducted a rct in Body mass index of 50 to 60 (n=60). Laparoscopic duodenal switch vs. Laparoscopic gastric bypass was evaluated on Reduction in body mass index (MD 8.5, 95% CI 4.9-12.2, p=<.001). Laparoscopic duodenal switch resulted in a significantly greater mean reduction in body mass index at 5 years compared with gastric bypass (mean difference 8.5; 95% CI 4.9-12.2; P<.001).