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

Maroun, Justin W.; Li, Mark; Oyefule, Omobolanle; Badaoui, Joseph N.; McKenzie, Travis J.; Kendrick, Michael L.; Kellogg, Todd A.; Ghanem, Omar M.

doi:10.1007/s00464-021-08850-y

Cited by 30 publications

(14 citation statements)

References 39 publications

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“…We found that differences in mean %TWL to be significantly different at 24 months with more weight loss in the higher BMI subgroup, a result not persistent at 60 months. The complication rates were very low overall and consistent with other studies, a testament to the safety of modern bariatric surgery 13,14. We observed a trend of slightly more long-term complications in the higher BMI subgroup that was not significant in multivariate analyses.…”

Section: Discussionsupporting

confidence: 90%

“…The complication rates were very low overall and consistent with other studies, a testament to the safety of modern bariatric surgery. 13,14 We observed a trend of slightly more long-term complications in the higher BMI subgroup that was not significant in multivariate analyses. Multivariate analysis controlled for confounding factors and demonstrated similar efficacy and safety at 60 months, despite preoperative ASA score, DM status, preoperative BMI or most importantly procedure type.…”

Section: Discussionmentioning

confidence: 59%

“…This study was not powered for comparison of procedure type impact on outcome and complication, but rather intended to guide the initial decision between surgeon and patient on the candidacy for bariatric surgical intervention. 13 The increased technical difficultly of BPD-DS and increased use of BPD-DS in the BMI > 60 kg/m 2 drives the trend of increased complications in this group, rather than obesity severity. Procedural length was used as another indicator of technical difficulty and there was no statistical difference between procedure length in the 2 BMI subgroups after multivariate analysis.…”

Section: Discussionmentioning

confidence: 98%

“…There is still debate on the optimal procedure to offer to individuals with a BMI >60 kg/m 2 . This study was not powered for comparison of procedure type impact on outcome and complication, but rather intended to guide the initial decision between surgeon and patient on the candidacy for bariatric surgical intervention 13. The increased technical difficultly of BPD-DS and increased use of BPD-DS in the BMI >60 kg/m 2 drives the trend of increased complications in this group, rather than obesity severity.…”

Section: Discussionmentioning

confidence: 99%

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Does BMI Matter? A 10-Year Single Institutional Experience on 571 Bariatric Surgery Patients With BMI >50 kg/m2

Badaoui¹,

Maroun²,

Oyefule³

et al. 2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Introduction: Patients undergoing bariatric surgery with body mass index (BMI) >50 kg/m2 are at a higher risk of surgical morbidity when compared with less obese patients, however, there is limited data correlating surgical risk and efficacy with increasing BMI in patients with severe obesity. We hypothesize that regardless of the degree above 50 kg/m2 their BMI, patients with severe obesity respond similarly to bariatric surgery. Materials and Methods: We performed a retrospective analysis of patients with BMI >50 kg/m2 who underwent biliopancreatic diversion with duodenal switch, Roux-en-Y gastric bypass, or sleeve gastrectomy at a single institution. Outcomes were compared in patients with a BMI between 50 and 60 kg/m2 to patients with a BMI >60 kg/m2 and included percent total weight loss as well as early and late complications. Statistical analyses were performed using logistic regression, univariate, and multivariate models. Results: There were 571 patients with BMI >50 kg/m2 who underwent bariatric surgery at our center, 170 (29.8%) had a BMI >60 kg/m2. Percent total weight loss was statistically significant between the BMI 50 and 60 kg/m2 and BMI >60 kg/m2 groups at 24 months (P=0.047) but not at 60 months (P=0.54). No significant difference was found in the incidence of early complications in a univariate (P=0.46) or a multivariate (P=0.06) analysis. The BMI >60 subgroup was associated with a higher rate of late complications in univariate analysis (heart rate=2.37; 1.03-5.47, P=0.04), but not in multivariate analysis (P=0.78). Conclusions: Efficacy and complication rates of bariatric surgeries are similar in patients with BMI 50 to 60 kg/m2 and >60 kg/m2, providing evidence supporting similar management of patients despite specific subgroups.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Does BMI Matter? A 10-Year Single Institutional Experience on 571 Bariatric Surgery Patients With BMI >50 kg/m2

Badaoui¹,

Maroun²,

Oyefule³

et al. 2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…Specifically, the DS modification includes replacing distal gastrectomy with sleeve gastrectomy preserving gastric function, and extending a common channel, decreasing malabsorption 5. In a study by Maroun et al,6 BPD-DS achieved higher weight reduction compared with sleeve gastrectomy and Roux-en-Y gastric bypass (RYGB) over 10 years. Moreover, previous meta-analyses have demonstrated BPD-DS as the most effective bariatric technique for weight loss 7,8.…”

mentioning

confidence: 99%

Single Versus Double Anastomosis Duodenal Switch in the Management of Obesity: A Meta-analysis and Systematic Review

Nakanishi

Matar

Vahibe

et al. 2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: Biliopancreatic diversion with duodenal switch (BPD-DS) is an effective yet technically challenging bariatric surgery with many complications. Alternatively, single anastomosis duodenalileal bypass with sleeve gastrectomy (SADI-S) was recently introduced as a simplified bariatric procedure. This meta-analysis aimed to assess the safety and efficacy of SADI-S compared with BPD-DS in the management of patients with obesity.Methods: Cochrane, Embase, PubMed, Scopus, and Web of Science were searched for articles from their inception to May 2022 by 2 independent reviewers using the Preferred Reporting Items for Systematic Reviews and Meta-analysis system. The review was registered prospectively with PROSPERO (CRD42022333521).Results: From 123 studies screened, 6 studies met the eligibility criteria, with a total of 1847 patients with obesity undergoing either SADI-S (n = 818) or BPD-DS (n = 1029). Preoperative body mass index was similar between the 2 groups, and the BPD-DS group had a greater % excess body mass index loss (EBMIL) (MD = −10.16%, 95% confidence interval: −11.80, −8.51, I 2 = 0%) at 2 years compared with the SADI-S group. There was no difference observed in preoperative comorbidities and remission, including diabetes, hypertension, and dyslipidemia between SADI-S and BPD-DS cohorts. Compared with BPD-DS, SADI-S had shorter hospital stays (MD = −1.36 d, 95% CI: −2.39, −0.33, I 2 = 86%), and fewer long-term ( > 30 d) complications (OR = 0.56, 95% CI: 0.42, 0.74, I 2 = 20%). Conversely, among nutritional deficiency outcomes, the SADI-S group had few patients with abnormal vitamin D (OR = 0.51, 95% CI: 0.36, 0.72, I 2 = 0%) values than the BPD-DS group.Conclusions: SADI-S has shown to be a possible alternative treatment option to BPD-DS in managing patients with obesity. Despite the promising results, further randomized controlled studies with more extended follow-up periods are necessary to ascertain the safety and efficacy of the treatment.

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Ten-Year Outcomes Following Roux-en-Y Gastric Bypass vs Duodenal Switch for High Body Mass Index

Salte,

Olbers,

Risstad

et al. 2024

JAMA Netw Open

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ImportanceResults from long-term follow-up after biliopancreatic diversion with duodenal switch (DS) are scarce.ObjectiveTo compare weight loss, health outcomes, and quality of life 10 years or more after Roux-en-Y-gastric bypass (RYGB) and DS surgery in patients with severe obesity—that is, a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 50 to 60.Design, Setting, and ParticipantsThis open-label randomized clinical trial was conducted at 2 academic bariatric centers in Sweden and Norway. Sixty patients with a BMI of 50 to 60 were included from March 1, 2006, to August 31, 2007. Data were analyzed from August 12, 2022, to January 25, 2023.InterventionsLaparoscopic RYGB or laparoscopic DS.Main Outcomes and MeasuresThe main outcome was change in BMI after 10 or more years. Secondary outcomes included anthropometric measures, lipid and glycemic profiles, bone mass density, adverse events, gastrointestinal tract symptoms, and health-related quality of life.ResultsForty-eight of the original 60 patients (80%) were assessed after a median of 12 (range, 9-13) years (mean [SD] age, 48.0 [6.0] years; 35 women [73%]). At follow-up, the mean BMI reductions were 11.0 (95% CI, 8.3-13.7) for RYGB and 20.3 (95% CI, 17.6-23.0) for DS, with a mean between-group difference of 9.3 (95% CI, 5.4-13.1; P &lt; .001). Total weight loss was 20.0% (95% CI, 15.3%-24.7%) for RYGB and 33.9% (95% CI, 27.8%-40.0%) for DS (P = .001). Mean serum lipid levels, except high-density lipoprotein cholesterol and hemoglobin A1c, improved more in the DS group during follow-up. Bone mass was reduced for both groups from 5 to 10 years, with lower bone mass after DS at 10 years. Quality-of-life scores (Obesity-Related Problem Scale and the 36-Item Short Form Health Survey) were comparable across groups at 10 years. The total number of adverse events was higher after DS (135 vs 97 for RYGB; P = .02). More patients in the DS group developed vitamin deficiencies (21 vs 11 for RYGB; P = .008) including 25-hydroxyvitamin D deficiency (19 for DS vs 9 for RYGB; P = .005). Four of 29 patients in the DS group (14%) developed severe protein-caloric malnutrition, of whom 3 (10%) underwent revisional surgery.Conclusions and RelevanceIn this randomized clinical trial, BMI reduction was greater after DS, but RYGB had a better risk profile over 10 years. Biliopancreatic diversion with DS may not be a better surgical strategy than RYGB for patients with a BMI of 50 to 60.Trial RegistrationClinicalTrials.gov Identifier: NCT00327912

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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

Cited by 30 publications

References 39 publications

Does BMI Matter? A 10-Year Single Institutional Experience on 571 Bariatric Surgery Patients With BMI >50 kg/m2

Does BMI Matter? A 10-Year Single Institutional Experience on 571 Bariatric Surgery Patients With BMI >50 kg/m2

Single Versus Double Anastomosis Duodenal Switch in the Management of Obesity: A Meta-analysis and Systematic Review

Ten-Year Outcomes Following Roux-en-Y Gastric Bypass vs Duodenal Switch for High Body Mass Index

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