Major Finding: Resolution of type 2 diabetes, hypertension, and hyperlipidemia was greatest among duodenal switch patients, at 82%, 67%, and 81%, vs. 64%, 39%, and 55% among Roux-en-Y gastric bypass patients.
Data Source: Data were taken from a chart review and prospective survey of 309 superobese patients.
Disclosures: Dr. Dorman reported no relevant conflicts of interest.
MADISON, WIS. – Total complication rates are high but comparable over the long term between duodenal switch surgery and Roux-en-Y gastric bypass, according to a propensity matched analysis of 309 superobese patients.
“Duodenal switch is a valid alternative to the Roux-en-Y gastric [RYGB] bypass,” especially if diabetes is present, Dr. Robert B. Dorman said. Duodenal switch appears to provide superior resolution of type 2 diabetes.
His conclusion is drawn from a study that focused on the long-term outcomes of 178 consecutive patients who underwent duodenal switch (DS) surgery and 139 propensity matched patients undergoing RYGB. In addition to a chart review, the University of Minnesota Bariatric Surgery Outcomes Survey tool was used to prospectively track patients' weight, comorbid illnesses, adverse outcomes, readmissions, and general health status. Mean follow-up was 3.7 years in the DS group and 6.2 years in the RYGB group.
There were five deaths in the DS group (postop day 38 and months 5, 7, 16, and 66) and three deaths in the RYGB group (postop months 3, 7, and 72), leaving 173 patients and 136 patients, respectively, in the analysis, Dr. Dorman said at the meeting.
Notably, weight loss in the two groups was comparable, decreasing from an average body mass index of 52 kg/m
Resolution of type 2 diabetes, hypertension, and hyperlipidemia was greatest among DS patients at 82%, 67%, and 81%, respectively, compared with 64%, 39%, and 55%, respectively, among RYGB patients.
DS patients, however, experienced significantly more loose stools, bloating, and heartburn than did RYGB patients, who had significantly more constipation. Nausea and emesis were comparable between the two groups.
With regard to complications, DS patients were significantly more likely to visit the emergency department than were RYGB patients (40% vs. 25%) and to experience hair loss (67% vs. 41%), Dr. Dorman said.
There was also a nonsignificant trend for DS patients to be readmitted more often than RYGB patients (25.4% vs. 23.5%) and to have more gastrointestinal leaks (1.7% vs. 0%), abdominal reoperations (29% vs. 23%), total parenteral nutrition/tube feeds (7.6% vs. 3%), and infusion therapy (28.5% vs. 23.5%). The RYGB patients, however, underwent more endoscopy (22% vs. 14%).
Dr. Dorman said providers should explain to patients the adverse symptoms they can expect following DS, but noted that the investigators “still feel DS should be limited to surgeons and centers with experience.”
Invited discussant Dr. James Wallace, a bariatric and general surgeon from the Medical College of Wisconsin, Milwaukee, described the 40% rate of ED visits in the DS group as “extreme,” and questioned the use of nutritional, vitamin, and protein supplementation – particularly in light of the observed hair loss. “I'm unconvinced that the incremental improvement in weight loss and resolution of metabolic derangements justifies the increased nutritional risk of the duodenal switch,” he said.
Dr. Dorman responded that the ED visits may represent a “knee-jerk reflex” on the part of DS patients when they experience a complication.
Duodenal switch seems to provide superior resolution to type 2 diabetes than Roux-en-Y gastric bypass, said Dr. Robert B. Dorman.
Source Patrice Wendling/IMNG Medical Media