Laparoscopic biliopancreatic diversion/duodenal switch or laparoscopic Roux-en-Y gastric bypass for super-obesity—weight loss versus side effects

Abstract

BackgroundLaparoscopic biliopancreatic diversion/duodenal switch (LDS) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the main surgical options for super-obese patients (body mass index >50 kg/m2). MethodsWe performed a medium long-term evaluation of 13 super-obese patients who had undergone LDS compared with a control group of 19 patients who had undergone LRYGB. The patients were assessed 31 months (range 17–38) and 34 months (range 26–62) after LDS and LRYGB, respectively, for body mass index changes, relief of co-morbidities, nutrition, quality of life, postoperative bowel function, and accumulated healthcare consumption. ResultsThe mean body mass index decreased from 54.9 to 30.0 kg/m2 in the LDS group and 57.8 to 39.8 kg/m2 in the LRYGB group (P = .005). The hemoglobin A1c level was lower in the LDS group than in the LRYGB group (3.8 ± .31% versus 4.3 ± .43%, respectively; P = .01). The LDS patients reported greater energy intake than the LRYGB patients (3132 ± 1392 kcal versus 2014 ± 656 kcal, respectively; P = .021). The number of stools daily was 4.1 ± 3.3 in the LDS group and 1.9 ± 1.1 in the LRYGB group, P = .0482). Of the 12 patients in the LDS group, 6 reported fecal incontinence or soiling compared with 2 of 16 in the LRYGB group (P = .034). The number of outpatient visits was 5.6 ± 4.6 for the LDS group and 2.0 ± 1.9 for the LRYGB group (P = .016), and the number of telephone consultations was 5.0 ± 5.6 and 1.4 ± 1.6 for the LDS and LRYGB groups, respectively (P = .043). ConclusionLDS resulted in greater weight loss than LRYGB in super-obese patients. However, the LDS patients in our series had more frequent gastrointestinal side effects, required greater doses of calcium and vitamin supplementation, and required more postoperative monitoring. Patient satisfaction was high in both groups.