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Ten year comparative analysis of sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch in patients with BMI ≥ 50 kg/m2

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Abstract

Introduction

Bariatric surgery is the most effective modality to stably reduce weight and related comorbidities in patients suffering from class II and III obesity. Data comparing long-term safety and efficacy of the three most effective bariatric operations are limited in patients with BMI ≥ 50 kg/m2, which complicate shared surgeon–patient decision making regarding optimal procedure selection.

Methods

A retrospective analysis was performed on all patients with BMI ≥ 50 kg/m2 who underwent biliopancreatic diversion with duodenal switch (BPD/DS), Roux-en-Y gastric bypass (RYGB), or sleeve gastrectomy (SG) at our institution between 2009 and 2019. Data collected from patients’ electronic medical records included operative details as well as BMI and presence and resolution of obesity-related comorbidities at 0, 6, 12, 24, 48, and 60 months post-operatively.

Results

Among 537 patients with BMI ≥ 50 kg/m2 who had a primary bariatric procedure, 93 patients underwent BPD/DS (17.3%), 341 patients underwent RYGB (63.5%), and 103 patients underwent SG (19.2%). BMI decreased by 23.7 kg/m2 in BPD/DS, 14.7 kg/m2 in RYGB, and 13.6 kg/m2 in SG cohorts at 60 months post-operatively (p < 0.0001). The greatest %TWL occurred in BPD/DS cohort (38.4%) followed by the RYGB (26.3%) and SG (23.6%) cohorts (p < 0.0001). The thirty-day complication rate was 12.9% for BPD/DS, 4.7% for RYGB, and 8.7% for SG (p = 0.015).

Conclusions

Our study demonstrated that the BPD/DS is the most effective operation at long-term reduction of BMI and achieved highest %TWL while SG and RYGB had similar results at 60 months post-op. BPD/DS is associated with increased early and late surgical complications compared to RYGB and SG.

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Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Justin Maroun, Mark Li, Omobolanle Oyefule, Joseph El Badaoui, Travis McKenzie, Michael Kendrick, Todd Kellogg & Omar M. Ghanem

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  1. Justin Maroun
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  2. Mark Li
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  3. Omobolanle Oyefule
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Correspondence to Omar M. Ghanem.

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Disclosures

Mr. Justin Maroun and Mr. Mark Li have no conflict of interest or financial ties to disclose. Drs. Omobolanle Oyefule, Joseph El Badaoui, Travis McKenzie, Michael Kendrick, Todd Kellogg and Omar Ghanem have no conflict of interest or financial ties to disclose.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of and was approved by the Institutional Review Board, and for this type of retrospective study, formal consent is not required.

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Maroun, J., Li, M., Oyefule, O. et al. Ten year comparative analysis of sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch in patients with BMI ≥ 50 kg/m2. Surg Endosc 36, 4946–4955 (2022). https://doi.org/10.1007/s00464-021-08850-y

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