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Comparison of 2-Year Results of Roux-en-Y Gastric Bypass and Transit Bipartition with Sleeve Gastrectomy for Superobesity

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Abstract

Purpose

Although Roux-en-Y gastric bypass is a powerful procedure, achieving and maintaining significant weight loss remains challenging in superobese populations. Transit bipartition with sleeve gastrectomy is derived from biliopancreatic diversion with duodenal switch and might improve weight loss control.

Materials and Methods

Two series of 71 primary laparoscopic Roux-en-Y gastric bypass (RYGB) and transit bipartition (TB) with a body mass index ≥ 50 kg/m2 were retrospectively compared after 2 years. Postoperative course, side effects, nutritional status, and weight outcomes were reviewed. Weight was expressed as BMI, percentage of excess BMI lost (%EBMIL), and percentage of total weight lost (%TWL).

Results

The 2 groups were comparable for age and BMI of 51.9 ± 1.8 for RYGB and 51.6 ± 5 for TB. TB was longer to perform (92 vs 74 min, p ≤ 0.001) with a 30-day complication rate of 4.2% and 5.6%, but there was 1 death after RYGB. Weight loss was greater after TB compared with RYGB with %EBMIL of 85.3 ± 15.8% vs 73.9 ± 17.2% (p = 0.0002). One TB patient suffered from protein malnutrition but none after RYGB. After TB, 7% of the patients experienced > 3 stools a day and 1 patient required revision, while 3 patients had diarrhea after RYGB. Late reoperations were required for 7 and 1 patients after RYGB and TB. Comorbidity improvement was similar.

Conclusion

In a superobese population, TB appeared relatively safer compared with RYGB. It achieved a better weight loss at 2 years with a trend for more digestive side effects.

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Authors and Affiliations

  1. Centre Médico-Chirurgical de l’Obésité, Clinique de l’Anjou, 142, avenue de Lattre de Tassigny, 49000, Angers, France

    Philippe Topart, Guillaume Becouarn & Jean-Baptiste Finel

Authors
  1. Philippe Topart
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  2. Guillaume Becouarn
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  3. Jean-Baptiste Finel
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Corresponding author

Correspondence to Philippe Topart.

Ethics declarations

All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. Individual informed consent was obtained for each patient undergoing TB after receiving information on the possible revision of the procedure either suppressing the small bowel short circuit in case of excessive side effects or converting to a “true” BPD-DS.

Conflict of Interest

Dr. Topart received honoraria for teaching from Ethicon and Medtronic as well as from Olympus. Dr. Becouarn received honoraria for teaching from Ethicon and Medtronic. Dr. Finel has no conflict of interest to report.

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Topart, P., Becouarn, G. & Finel, JB. Comparison of 2-Year Results of Roux-en-Y Gastric Bypass and Transit Bipartition with Sleeve Gastrectomy for Superobesity. OBES SURG 30, 3402–3407 (2020). https://doi.org/10.1007/s11695-020-04691-1

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