Many would agree, but a recent RCT has challenged that:

JAMA Surg. 2015;150(4):352-361.

Five-Year Outcomes After Laparoscopic Gastric Bypass and Laparoscopic Duodenal Switch in Patients With Body Mass Index of 50 to 60

A Randomized Clinical Trial

Hilde Risstad, et al

ABSTRACT:

IMPORTANCE

There is no consensus as to which bariatric procedure is preferred to reduce

weight and improve health in patients with a body mass index higher than 50.

OBJECTIVE

To compare 5-year outcomes after Roux-en-Y gastric bypass (gastric bypass) and

biliopancreatic diversion with duodenal switch (duodenal switch).

DESIGN, SETTING, AND PARTICIPANTS

Randomized clinical open-label trial at Oslo University Hospital, Oslo, Norway, and Sahlgrenska University Hospital, Gothenburg, Sweden. Participants were recruited between March 17, 2006, and August 20, 2007, and included 60 patients aged 20 to 50 years with a body mass index of 50 to 60. The current study provides the 5-year follow-up analyses by intent to treat, excluding one participant accepted for inclusion who declined being operated on prior to knowing to what group hewas randomized.

INTERVENTIONS

Laparoscopic gastric bypass and laparoscopic duodenal switch.

MAIN OUTCOMES AND MEASURES

Body mass index and secondary outcomes including anthropometric measures, cardiometabolic risk factors, pulmonary function, vitamin status, gastrointestinal symptoms, health-related quality of life, and adverse events.

RESULTS

Sixty patients were randomly assigned and operated on with gastric bypass (n = 31) and duodenal switch (n = 29). Fifty-five patients (92%) completed the study. Five years after surgery, the mean reductions in body mass index were 13.6 (95%CI, 11.0-16.1) and 22.1 (95% CI, 19.5-24.7) after gastric bypass and duodenal switch, respectively. The mean between-group difference was 8.5 (95%CI, 4.9-12.2; P < .001). Remission rates of type 2 diabetes mellitus and metabolic syndrome and changes in blood pressure and lung function were similar between groups. Reductions in total cholesterol, low-density lipoprotein cholesterol, triglycerides, and fasting glucose were significantly greater after duodenal switch compared with gastric bypass. Serum concentrations of vitamin A and 25-hydroxyvitamin D were significantly reduced after duodenal switch compared with gastric bypass. Duodenal switch was associated with more gastrointestinal adverse effects. Health-related quality of life was similar between groups. Patients with duodenal switch underwent more surgical procedures related to the initial procedure (13 [44.8%] vs 3 [9.7%] patients; P = .002) and had significantly more hospital admissions compared with patients with gastric bypass.

CONCLUSIONS AND RELEVANCE

In patients with a body mass index of 50 to 60, duodenal switch resulted in greater weight loss and greater improvements in low-density lipoprotein cholesterol, triglyceride, and glucose levels 5 years after surgery compared with gastric bypass while improvements in health-related quality of life were similar. However, duodenal switch was associated with more surgical, nutritional, and gastrointestinal adverse effects.

TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00327912

Dear Dr. Novik,

Thanks for your input. Is 'duodenal switch' the same as 'duodeno-jejunal bypass' ?

A duodenal switch bypasses the duodenum, the jejunum and a significant part of the ileum. It is always combined with a sleeve gastrectomy. In fact, it preceded the idea of a so-called "stand alone" sleeve gastrectomy.

In general Duodenal switch is not a suitable operation for Indians.The longer the Biliopancreatic limb the more is the metabolic effect consequently RYGB has less metabolic effect.Last week one of our MGB with 250 cm BP limb,Diabetes showed resolution on 3 rd day itself so as with sleeve with sigle anastamosis DJB..single anastamosis DJB with stratafix knotless suture is comparativelly easier to do.

Thanks for your input sir. But what  about the nutritional complications associated with such a long limb?