Abstract
Background
This study presents late results of a previously published 2-year prospective comparison between Roux-en-Y gastric bypass (RYGBP) versus biliopancreatic diversion with Roux-en-Y gastric bypass (BPD-RYGBP) in an exclusively non-superobese population.
Methods
From a cohort of 130 patients with a BMI of 35–50 kg/m2, 65 were randomly selected to undergo RYGBP and 65 to BPD-RYGBP. All underwent follow-up evaluation at 1, 3, 6, and 12 months postoperatively and every year thereafter.
Results
Follow-up at the eighth year was achieved in 60 % of the BPD-RYGBP and in 58 % of the RYGBP group (p = 1.00). Mean excess weight loss (EWL%), was significantly higher following BPD-RYGBP (76.89 ± 1.53) as compared to RYGBP (67.17 ± 1.43) (p = 0.0004). The mean success rate (percentage of patients with EWL% ≥50 %) was significantly higher after BPD-RYGBP (95.85 ± 1.01) than RYGBP (75.91 ± 3.58) (p = 0.0001). No significant differences were observed for late non-metabolic complications. The incidence of anemia, iron deficiency, B12 deficiency, and low-ferritin levels was relatively high in both groups with not always significant differences. Severe protein malnutrition occurred in four patients (three BPD-RYGBP and one RYGBP) (p = 0.37). In only one BPD-RYGBP patient (1.54 %) was revision surgery to RYGBP necessary, due to recurrent episodes of hypoproteinemia. The remaining patients were treated successfully with total parenteral nutrition and nutritional counseling.
Conclusions
Late results presented in this paper agree with the previously published 2-year results of the same patient cohort. Although both procedures are safe and effective, BPD-RYGBP seems to prevail in terms of successful weight loss without a significantly higher incidence of metabolic and non-metabolic complications.
Similar content being viewed by others
References
Buchwald H. Overview of bariatric surgery. J Am Coll Surg. 2002;194:367–75.
Pournaras DJ, Aasheim ET, Bueter M, et al. Effect of bypassing the proximal gut hormones involved with glycemic control and weight loss. Surg Obes Relat Dis. 2012;8:371–4.
Chronaiou A, Tsoli M, Kehagias I, et al. Lower ghrelin levels and exaggerated postprandial peptide-YY, glucagon-like peptide-1 and insulin responses, after gastric fundus resection, in patients undergoing Roux-en-Y gastric bypass: a randomized clinical trial. Obes Surg. 2012;22:1761–70.
Brolin RE, Leung M. Survey of vitamin and mineral supplementation after gastric bypass and biliopancreatic diversion for morbid obesity. Obes Surg. 1999;9:150–4.
Biertho L, Biron S, Hould FS, et al. Is biliopancreatic diversion with duodenal switch indicated for patients with body mass index <50kg/m2? Surg Obes Relat Dis. 2010;6:508–14.
Skroubis G, Anesidis S, Kehagias I, et al. Roux-en-Y gastric bypass versus a variant of biliopancreatic diversion in a non-superobese population: prospective comparison of the efficacy and the incidence of metabolic deficiencies. Obes Surg. 2006;16:488–95.
Kalfarentzos F, Skroubis G, Karamanakos S, et al. Biliopancreatic diversion with Roux-en-Y gastric bypass and long limbs: advances in surgical treatment for super-obesity. Obes Surg. 2011;21:1849–58.
Prachand VN, Davee RT, Alverdy JC. Duodenal switch provides superior weight loss in the superobese (BMI ≥50 kg/m2) compared with gastric bypass. Ann Surg. 2006;244:611–9.
Brolin RE, LaMarca LB, Kenler HA, et al. Malabsorptive gastric bypass in patients with superobesity. J Gastrointest Surg. 2002;6:195–203.
Kalfarentzos F, Papadoulas S, Skroubis G, et al. Prospective evaluation of biliopancreatic diversion with Roux-en-Y gastric bypass in the super obese. J Gastrointest Surg. 2004;8:479–88.
Buchwald H. A bariatric surgery algorithm. Obes Surg. 2002;12:733–46.
Kalfarentzos F, Dimakopoulos A, Kehagias I, et al. Vertical banded gastroplasty versus standard or distal Roux-en-Y gastric bypass based on specific selection criteria in the morbidly obese: preliminary results. Obes Surg. 1999;9:433–42.
Kalfarentzos F, Skroubis G, Kehagias I, et al. A prospective comparison of vertical banded gastroplasty and Roux-en-Y gastric bypass in a non-superobese population. Obes Surg. 2006;16:151–8.
Kehagias I, Karamanakos SN, Argentou M, et al. Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the management of patients with BMI <50 kg/m2. Obes Surg. 2011;21:1650–6.
Larrad-Jimenez A, Diaz-Guerra CS, de Cuadros BP, et al. Short-, mid-, and long-term results of Larrad biliopancreatic diversion. Obes Surg. 2007;17:202–10.
Marceau P, Biron S, Hould FS, et al. Duodenal switch: long-term results. Obes Surg. 2007;17:1421–30.
Gracia JA, Elia M, Aguilella V, et al. Obesity surgery results depending on technique performed: long-term outcome. Obes Surg. 2009;19:432–8.
Scopinaro N, Marinari G, Camerini G, et al. Biliopancreatic diversion for obesity: state of the art. Surg Obes Relat Dis. 2005;1:317–28.
Inabnet WB, Quinn T, Gagner M, et al. Laparoscopic Roux-en-Y gastric bypass in patients with BMI <50: a prospective randomized trial comparing short and long limb lengths. Obes Surg. 2005;15:51–7.
Thurnheer M, Bisang P, Ernst B, et al. A novel distal very long Roux-en-Y gastric bypass (DVLRYGB) as a primary bariatric procedure—complication rates, weight loss and nutritional/metabolic changes in the first 355 patients. Obes Surg. 2012;22:1427–36.
Nelson DW, Blair KS, Martin MJ. Analysis of obesity-related outcomes and bariatric failure rates with the duodenal switch vs gastric bypass for morbid obesity. Arch Surg. 2012;147:847–54.
Skroubis G, Sakellaropoulos G, Pouggouras K, et al. Comparison of nutritional deficiencies after Roux-en-Y gastric bypass and after biliopancreatic diversion with Roux-en-Y gastric bypass. Obes Surg. 2002;12:551–8.
Skroubis G, Karamanakos S, Sakellaropoulos G, et al. Comparison of early and late complications after various bariatric procedures: incidence and treatment during 15 years at a single institution. World J Surg. 2011;35:93–101.
Conflict of Interest
All the authors declare that they have no conflict of interest
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Skroubis, G., Kouri, N., Mead, N. et al. Long-Term Results of a Prospective Comparison of Roux-en-Y Gastric Bypass versus a Variant of Biliopancreatic Diversion in a Non-Superobese Population (BMI 35–50 kg/m2). OBES SURG 24, 197–204 (2014). https://doi.org/10.1007/s11695-013-1081-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-013-1081-1