Based on five-year follow-up of patients in a randomized clinical trial, researchers have concluded that gastric bypass is the preferred treatment for extreme obesity. This is despite the fact that it is not as effective in reducing body weight as the so-called duodenal switch.
The outcomes, which appear in the current issue of JAMA Surgery, show that duodenal switch leads to substantially better weight reduction but is associated with a higher risk of complications.
"There has not been any consensus about the recommended surgical procedure for patients with BMI greater than 50 who have extreme obesity," says Torsten Olbers, Associate Professor of Surgery at Sahlgrenska Academy, University of Gothenburg, and senior consultant surgeon.
The study was conducted as a collaborative effort between Sahlgrenska University Hospital and Oslo University Hospital. Sixty patients with extreme obesity who weighed an average of 353 pounds were randomly assigned to receive one of the two procedures.
At five-year follow-up, those who had undergone duodenal switch lost an average of 146 pounds, as opposed to 90 pounds among those who had received gastric bypass surgery. The improvement in blood lipid and blood glucose levels was also more pronounced.
Nevertheless, duodenal switch was more likely to cause adverse effects. These patients were more prone to develop diarrhea and other gastrointestinal ailments.
A number of patients were hospitalized for malnutrition, while some required new operations to address problems occasioned by the original surgery.
Use with great caution
"Despite the greater efficacy of duodenal switch when it comes to weight reduction, our findings suggest that it should be used with caution, given the higher percentage of long-term adverse effects," Dr. Olbers says.
The two groups showed similar improvement in terms of remission of type 2 diabetes, risk factors for cardiovascular disease and perceived quality of life.
Source: University of Gothenburg