Journal of Gastrointestinal Surgery

, Volume 14, Issue 2, pp 211–220

Duodenal Switch Provides Superior Resolution of Metabolic Comorbidities Independent of Weight Loss in the Super-obese (BMI ≥ 50 kg/m2) Compared with Gastric Bypass

2009 SSAT Plenary Presentation

DOI: 10.1007/s11605-009-1101-6

Cite this article as:
Prachand, V.N., Ward, M. & Alverdy, J.C. J Gastrointest Surg (2010) 14: 211. doi:10.1007/s11605-009-1101-6



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.


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

Copyright information

© The Society for Surgery of the Alimentary Tract 2009

Authors and Affiliations

  • Vivek N. Prachand
    • 1
  • Marc Ward
    • 2
  • John C. Alverdy
    • 1
  1. 1.Section of General Surgery, Department of SurgeryUniversity of Chicago Medical CenterChicagoUSA
  2. 2.Pritzker School of MedicineUniversity of ChicagoChicagoUSA

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