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Duodenal Switch Provides Superior Weight Loss in the Super-Obese (BMI ≥50kg/m2) Compared With Gastric Bypass

Prachand, Vivek N. MD; DaVee, Roy T. BS; Alverdy, John C. MD

doi: 10.1097/01.sla.0000239086.30518.2a
Original Articles and Discussions

Objectives: Although weight loss following Roux-en-Y gastric bypass is acceptable in patients with preoperative body mass index (BMI) between 35 and 50 kg/m2, results from several series demonstrate that failure rates approach 40% when BMI is ≥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 (RYGB).

Methods: All super-obese patients (BMI ≥50 kg/m2) undergoing standardized laparoscopic and open DS and RYGB between August 2002 and October 2005 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. χ2 analysis was used to determine the rate of successful weight loss, defined as achieving at least 50% loss of excess body weight.

Results: A total of 350 super-obese patients underwent DS (n = 198) or RYGB (n = 152) with equal 30-day mortality (DS,1 of 198; RYGB, 0 of 152; P = not significant). The % EBWL at follow-up was greater for DS than RY (12 months, 64.1% vs. 55.9%; 18 months, 71. 9% vs. 62.8%; 24 months, 71.6% vs. 60.1%; 36 months, 68.9% vs. 54.9%; 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, 83.9% vs. 70.4%; 18 months, 90.3% vs. 75.9%; 36 months, 84.2% vs. 59.3%; P < 0.05).

Conclusions: Direct comparison of DS to RYGB demonstrates superior weight loss outcomes for DS.

A total of 350 super-obese patients underwent duodenal switch (DS) or Roux-en-Y gastric bypass (RYGB). Weight loss, decrease in body mass index, percent excess body weight loss, and likelihood of successful weight loss were greater for the DS than RYGB.

From the University of Chicago, Chicago, IL.

Reprints: Vivek N. Prachand, MD, University of Chicago, 5841 S. Maryland Ave., MC 5036, Chicago, IL 60637. E-mail:

© 2006 Lippincott Williams & Wilkins, Inc.