Weight-Loss Surgery Options Compared in Super-Obese

03 june 2009-- A technique called duodenal switch surgery may be more effective than gastric bypass surgery for patients with obesity-related medical problems such as high cholesterol, diabetes and high blood pressure, according to a U.S. study that included 350 super-obese patients who were more than 200 pounds heavier than their ideal body weight.

The findings were presented Monday at Digestive Disease Week 2009 in Chicago.

In gastric bypass surgery, surgeons create a small gastric pouch that's separate from the rest of the stomach, but with duodenal switch surgery, the stomach is reshaped into a long narrow tube and the small intestine is reconfigured to reduce calorie absorption, according to a Digestive Disease Week news release.

In their new study, Dr. Vivek N. Prachand, an assistant professor of surgery at the University of Chicago, and colleagues looked at the rates of resolution of obesity-related diseases (whether patients were able to stop taking medications to treat their conditions) three years after either duodenal switch or gastric bypass surgery.

The rates of resolution for duodenal switch and gastric bypass were: diabetes, 100 percent vs. 60 percent; high blood pressure, 68 percent vs. 38.6 percent; high cholesterol, 72 percent vs. 26 percent; acid reflux; 48.5 percent vs. 76.9 percent, the study authors found.

In previous research, Prachand's team showed that super-obese patients who underwent duodenal switch surgery had better weight loss than those who had gastric bypass surgery. They believed that the greater weight loss among duodenal switch patients may explain why they had higher rates of resolution of obesity-related diseases. But this new study didn't find a link between amount of weight loss and resolution of obesity-related conditions, which suggests that other mechanisms besides weight loss may be at work.

The researchers also noted that reduced absorption of calories in duodenal switch surgery patients can lead to vitamin/nutrition deficiencies and, possibly, malnutrition.

"The effort to better manage the potential vitamin and nutritional deficiencies associated with duodenal switch surgery is worthwhile because it appears that the duodenal switch surgery is more successful in terms of weight loss and resolution of significant obesity-related disease for super-obese patients," Prachand said in the news release.