Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul;36(7):4946-4955.
doi: 10.1007/s00464-021-08850-y. Epub 2021 Nov 3.

Ten year comparative analysis of sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch in patients with BMI ≥ 50 kg/m2

Justin Maroun  1 , Mark Li  1 , Omobolanle Oyefule  1 , Joseph El Badaoui  1 , Travis McKenzie  1 , Michael Kendrick  1 , Todd Kellogg  1 , Omar M Ghanem  2
Affiliations

Ten year comparative analysis of sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch in patients with BMI ≥ 50 kg/m2

Justin Maroun et al. Surg Endosc. 2022 Jul.

Abstract

Introduction: Bariatric surgery is the most effective modality to stably reduce weight and related comorbidities in patients suffering from class II and III obesity. Data comparing long-term safety and efficacy of the three most effective bariatric operations are limited in patients with BMI ≥ 50 kg/m2, which complicate shared surgeon-patient decision making regarding optimal procedure selection.

Methods: A retrospective analysis was performed on all patients with BMI ≥ 50 kg/m2 who underwent biliopancreatic diversion with duodenal switch (BPD/DS), Roux-en-Y gastric bypass (RYGB), or sleeve gastrectomy (SG) at our institution between 2009 and 2019. Data collected from patients' electronic medical records included operative details as well as BMI and presence and resolution of obesity-related comorbidities at 0, 6, 12, 24, 48, and 60 months post-operatively.

Results: Among 537 patients with BMI ≥ 50 kg/m2 who had a primary bariatric procedure, 93 patients underwent BPD/DS (17.3%), 341 patients underwent RYGB (63.5%), and 103 patients underwent SG (19.2%). BMI decreased by 23.7 kg/m2 in BPD/DS, 14.7 kg/m2 in RYGB, and 13.6 kg/m2 in SG cohorts at 60 months post-operatively (p < 0.0001). The greatest %TWL occurred in BPD/DS cohort (38.4%) followed by the RYGB (26.3%) and SG (23.6%) cohorts (p < 0.0001). The thirty-day complication rate was 12.9% for BPD/DS, 4.7% for RYGB, and 8.7% for SG (p = 0.015).

Conclusions: Our study demonstrated that the BPD/DS is the most effective operation at long-term reduction of BMI and achieved highest %TWL while SG and RYGB had similar results at 60 months post-op. BPD/DS is associated with increased early and late surgical complications compared to RYGB and SG.

Keywords: Bariatric surgery; Duodenal switch; Roux-en-Y bypass; Sleeve gastrectomy; Superobese.

PubMed Disclaimer

References

    1. Abd El Aziz MA et al (2020) Colectomy for patients with super obesity: current practice and surgical morbidity in the United States. Surg Obes Relat Dis 16(11):1764–1769 - DOI
    1. Stephens DJ et al (2008) Short-term outcomes for super-super obese (BMI > or =60 kg/m2) patients undergoing weight loss surgery at a high-volume bariatric surgery center: laparoscopic adjustable gastric banding, laparoscopic gastric bypass, and open tubular gastric bypass. Surg Obes Relat Dis 4(3):408–415 - DOI
    1. Cardoso L et al (2017) Short- and long-term mortality after bariatric surgery: a systematic review and meta-analysis. Diabetes Obes Metab 19(9):1223–1232 - DOI
    1. English WJ et al (2020) American Society for metabolic and bariatric surgery 2018 estimate of metabolic and bariatric procedures performed in the United States. Surg Obes Relat Dis 16(4):457–463 - DOI
    1. Ding L et al (2020) Comparative effectiveness of bariatric surgeries in patients with obesity and type 2 diabetes mellitus: a network meta-analysis of randomized controlled trials. Obes Rev 21(8):e13030 - DOI

LinkOut - more resources