title: Analysis of obesity-related outcomes and bariatric failure rates with the duodenal switch vs gastric bypass for morbid obesity.
abstract: OBJECTIVE
  To compare the outcomes of a large cohort undergoing biliopancreatic diversion/duodenal switch (DS) vs gastric bypass (GB).
  
  
  METHODS
  Retrospective review of the Bariatric Outcomes Longitudinal Database from 2007 to 2010. All inpatient and outpatient follow-up data were analyzed.
  
  
  METHODS
  Multicenter database.
  
  
  METHODS
  Patients undergoing primary DS were compared with a concurrent cohort undergoing GB.
  
  
  METHODS
  The main outcome measures were (1) weight loss; (2) control of comorbidities including diabetes mellitus, hypertension, and sleep apnea; and (3) failure to achieve at least 50% excess body weight loss.
  
  
  RESULTS
  One thousand five hundred forty-five patients underwent DS and 77 406 underwent GB, with a mean preoperative body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 52 and 48, respectively (P < .01). The DS was associated with longer operative times, greater blood loss, and longer lengths of hospital stay (all P < .05). Early reoperation rates were higher in the DS group (3.3% vs 1.5%). Percentage of change in BMI was significantly greater in the DS group at all follow-up intervals (P < .05). Subgroup analysis of the superobese population (BMI >50) revealed significantly greater percentage of excess body weight loss in the DS group at 2 years (79% vs 67%; P < .01). Comorbidity control of diabetes, hypertension, and sleep apnea were all superior with the DS (all P < .05). The risk of weight loss failure was significantly reduced with DS vs GB for all patients, with a greater reduction in the BMI more than 50 subgroup.
  
  
  CONCLUSIONS
  The DS is a less commonly used bariatric operation, with higher early risks compared with GB. However, the DS achieved better weight and comorbidity control, with even more pronounced benefits among the superobese.
authors.affiliation: Department of Surgery, Madigan Army Medical Center, Ft Lewis, WA 98431, USA.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Nelson
authors.forename: Kelly S
authors.initials: KS
authors.lastname: Blair
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Martin
mesh_terms: D000714:Anastomosis, Surgical; D050110:Bariatric Surgery; D004386:Duodenum / Q000601:surgery*; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome