title: Distal gastric bypass/duodenal switch procedure, Roux-en-Y gastric bypass and biliopancreatic diversion in a community practice.
abstract: BACKGROUND
  Hybrid procedures combining purely restrictive and purely malabsorptive components to achieve stable long-term weight reduction have evolved since the 1970s. In a solo surgical community-based practice over the period 1984-1997, three different hybrid procedures were utilized as primary operations in patients who had not had prior bariatric surgery.
  
  
  METHODS
  Restrospective comparison of 32 patients who underwent biliopancreatic diversion (BPD), 138 patients who underwent distal gastric bypass Roux-en-Y (RGB) and 105 patients undergoing distal gastric bypass/duodenal switch procedure (DS) with 2-4 year follow-up in 37 DS patients.
  
  
  RESULTS
  Height, initial weight and initial body mass index (BMI) were similar in the three groups. The DS patients were older. Mean BMI at 2 years fell from 49 to 29 kg/m2 in both DS and RGB. Mean percentage maximum preoperative weight lost was 40% in both the DS and RGB groups. Two-year mean percentage excess weight lost in DS was 78%, compared to 74% in RGB. There were no operative deaths and no ulcers in the DS group.
  
  
  CONCLUSIONS
  DS is an important new option for primary treatment of morbid obesity. It can be performed safely, with up to 4 year follow-up showing stable weight loss.
authors.affiliation: Pacific Institute of Surgery for Obesity, Ventura, California 93003, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Rabkin
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y; D015904:Biliopancreatic Diversion / Q000009:adverse effects; D015992:Body Mass Index; D001835:Body Weight; D004386:Duodenum / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012189:Retrospective Studies; D015431:Weight Loss