title: Superior weight loss and lower HbA1c 3 years after duodenal switch compared with Roux-en-Y gastric bypass--a randomized controlled trial.
abstract: BACKGROUND
  Obesity is a rising threat to public health. The relative increase in the incidence of morbid obesity is most pronounced in the most severely obese. Roux-en-Y gastric bypass (RYGB) results in inferior weight loss in this group. Therefore, we have offered biliopancreatic diversion with duodenal switch (BPD/DS) as an alternative for this patient category. Our objective was to compare BPD/DS and RYGB in the surgical treatment of morbid obesity in patients with a body mass index (BMI) >48 kg/m(2). The setting was a university hospital in Sweden.
  
  
  METHODS
  In a controlled trial (registration number ISRCTN10940791), 47 patients (25 men, BMI 54.5 ± 6.1 kg/m(2)) were randomized to RYGB (n = 23) or BPD/DS (n = 24). Biochemical data were collected preoperatively and 1 and 3 years postoperatively. A questionnaire addressing weight, general satisfaction, and gastrointestinal symptoms was distributed a median of 4 years postoperatively.
  
  
  RESULTS
  Both procedures were safe. The duration of surgery and postoperative morphine consumption were greater after BPD/DS than after RYGB (157 versus 117 min and 140 versus 93 mg, respectively). BPD/DS resulted in greater weight loss than RYGB (-23.2 ± 4.9 versus -16.2 ± 6.9 BMI units or 80% ± 15% versus 51% ± 23% excess BMI loss, P <.001). BPD/DS yielded lower glucose and glycated hemoglobin levels at 3 years. More patients listed troublesome diarrhea and malodorous flatus in the questionnaire after BPD/DS, but no significant difference was seen (P = .078 and P = .073, respectively).
  
  
  CONCLUSIONS
  BPD/DS produced superior weight results and lower glycated hemoglobin levels compared with RYGB in patients with a BMI >48 kg/m(2). Both operations yield high satisfaction rates. However, diarrhea tended to be more common after BPD/DS.
authors.affiliation: Department of Surgical Sciences, Uppsala University, Uppsala, Sweden. jakob.hedberg@surgsci.uu.se
authors.forename: Jakob
authors.initials: J
authors.lastname: Hedberg
authors.forename: Magnus
authors.initials: M
authors.lastname: Sundbom
mesh_terms: D000328:Adult; D015904:Biliopancreatic Diversion / Q000379:methods*; D001786:Blood Glucose / Q000378:metabolism; D048909:Diabetes Complications / Q000097:blood / Q000150:complications; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007902:Length of Stay; D008297:Male; D009767:Obesity, Morbid / Q000097:blood / Q000601:surgery*; D017060:Patient Satisfaction; D011182:Postoperative Care; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin