Duodenal Switch Provides Superior Resolution of Metabolic Comorbidities Independent of Weight Loss in the Super-obese (BMI >= 50 kg/m(2)) Compared with Gastric Bypass

作者：Prachand Vivek N^*; Ward Marc; Alverdy John C

来源：Journal of Gastrointestinal Surgery, 2010, 14(2): 211-219.

DOI：10.1007/s11605-009-1101-6

• Morbid obesity
• Super-obesity
• Comorbidity resolution
• Duodenal switch
• Gastric bypass
• Bariatric surgery
• Diabetes
• Gastroesophageal reflux
• Biliopancreatic diversion

Increased body mass index is associated with greater incidence and severity of obesity-related comorbidities and inadequate postbariatric surgery weight loss. Accordingly, comorbidity resolution is an important measure of surgical outcome in super-obese individuals. We previously reported superior weight loss in super-obese patients following duodenal switch (DS) compared to Roux-en-Y gastric bypass (RYGB) in a large single institution series. We now report follow-up comparison of comorbidity resolution and correlation with weight loss.
Data from patients undergoing DS and RYGB between August 2002 and October 2005 were prospectively collected and used to identify super-obese patients with diabetes, hypertension, dyslipidemia, and gastroesophageal reflux disease (GERD). Ali-Wolfe scoring was used to describe comorbidity severity. Chi-square analysis was used to compare resolution and two-sample t tests used to compare weight loss between patients whose comorbidities resolved and persisted.
Three hundred fifty super-obese patients [DS (n = 198), RYGB (n = 152)] were identified. Incidence and severity of hypertension, dyslipidemia, and GERD was comparable in both groups while diabetes was less common but more severe in the DS group (24.2% vs. 35.5%, Ali-Wolfe 3.27 vs. 2.94, p < 0.05). Diabetes, hypertension, and dyslipidemia resolution was greater at 36 months for DS (diabetes, 100% vs. 60%; hypertension, 68.0% vs. 38.6%; dyslipidemia, 72% vs. 26.3%), while GERD resolution was greater for RYGB (76.9% vs. 48.57%; p < 0.05). There were no differences in weight loss between comorbidity "resolvers" and "persisters".
In comparison to RYGB, DS provides superior resolution of diabetes, hypertension, and dyslipidemia in the super-obese independent of weight loss.

• 出版日期2010-2