Surgery results in greater improvement in weight loss outcomes and weight associated comorbidities compared with non-surgical interventions , regardless of the type of procedures used .
When compared with each other , certain procedures result ed in greater weight loss and improvements in comorbidities than others .
Outcomes were similar between RYGB and sleeve gastrectomy , and both of these procedures had better outcomes than adjustable gastric b and ing .
For people with very high BMI , biliopancreatic diversion with duodenal switch result ed in greater weight loss than RYGB .
Isolated sleeve gastrectomy led to better weight-loss outcomes than adjustable gastric b and ing after three years follow-up .
BACKGROUND Bariatric ( weight loss ) surgery for obesity is considered when other treatments have failed .
The effects of the available bariatric procedures compared with medical management and with each other are uncertain .
This is an up date of a Cochrane review first published in 2003 and most recently up date d in 2009 .
OBJECTIVES To assess the effects of bariatric surgery for overweight and obesity , including the control of comorbidities .
Weight Loss, Cardiovascular Risk Factors, and Quality of Life After Gastric Bypass and Duodenal Switch
BACKGROUND Gastric bypass and duodenal switch are currently performed bariatric surgical procedures . Uncontrolled studies suggest that duodenal switch induces greater weight loss than gastric bypass . OBJECTIVE To determine whether duodenal switch leads to greater weight loss and more favorable improvements in cardiovascular risk factors and quality of life than gastric bypass . DESIGN R and omized , parallel-group trial . ( Clinical Trials.gov registration number : NCT00327912 ) SETTING 2 academic medical centers ( 1 in Norway and 1 in Sweden ) . PATIENTS 60 participants with a body mass index ( BMI ) between 50 and 60 kg/m(2 ) . INTERVENTION Gastric bypass ( n = 31 ) or duodenal switch ( n = 29 ) . MEASUREMENTS The primary outcome was the change in BMI after 2 years . Secondary outcomes included anthropometric measures ; concentrations of blood lipids , glucose , insulin , C-reactive protein , and vitamins ; and health-related quality of life and adverse events . RESULTS Fifty-eight of 60 participants ( 97 % ) completed the study . The mean reductions in BMI were 17.3 kg/m(2 ) ( 95 % CI , 15.7 to 19.0 kg/m(2 ) ) after gastric bypass and 24.8 kg/m(2 ) ( CI , 23.0 to 26.5 kg/m(2 ) ) after duodenal switch ( mean between-group difference , 7.44 kg/m(2 ) [ CI , 5.24 to 9.64 kg/m(2 ) ] ; P < 0.001 ) . Total cholesterol concentration decreased by 0.24 mmol/L ( CI , -0.03 to 0.50 mmol/L ) ( 9.27 mg/dL [ CI , -1.16 to 19.3 mg/dL ] ) after gastric bypass and 1.07 mmol/L ( CI , 0.79 to 1.35 mmol/L ) ( 41.3 mg/dL [ CI , 30.5 to 52.1 mg/dL ] ) after duodenal switch ( mean between-group difference , 0.83 mmol/L [ CI , 0.48 to 1.18 mmol/L ] ; 32.0 mg/dL [ CI , 18.5 to 45.6 mg/dL ] ; P ≤ 0.001 ) . Reductions in low-density lipoprotein cholesterol concentration , anthropometric measures , fat mass , and fat-free mass were also greater after duodenal switch ( P ≤ 0.010 for each between-group comparison ) . Both groups had reductions in blood pressure and mean concentrations of glucose , insulin , and C-reactive protein , with no between-group differences . The duodenal switch group , but not the gastric bypass group , had reductions in concentrations of vitamin A and 25-hydroxyvitamin D. Most Short Form-36 Health Survey dimensional scores improved in both groups , with greater improvement in 1 of 8 domains ( bodily pain ) after gastric bypass . From surgery until 2 years , 10 participants ( 32 % ) had adverse events after gastric bypass and 18 ( 62 % ) after duodenal switch ( P = 0.021 ) . Adverse events related to malnutrition occurred only after duodenal switch . LIMITATION Clinical experience was greater with  gastric  bypass than with duodenal switch at the study centers . CONCLUSION Duodenal switch surgery was associated with greater weight loss , greater reductions of total and low-density lipoprotein cholesterol concentrations , and more adverse events . Improvements in other cardiovascular risk factors and quality of life were similar after both procedures . PRIMARY FUNDING SOURCE South-Eastern Norway Regional Health Authority
Surgery results in greater improvement in weight loss outcomes and weight associated comorbidities compared with non-surgical interventions , regardless of the type of procedures used .
When compared with each other , certain procedures result ed in greater weight loss and improvements in comorbidities than others .
Outcomes were similar between RYGB and sleeve gastrectomy , and both of these procedures had better outcomes than adjustable gastric b and ing .
For people with very high BMI , biliopancreatic diversion with duodenal switch result ed in greater weight loss than RYGB .
Isolated sleeve gastrectomy led to better weight-loss outcomes than adjustable gastric b and ing after three years follow-up .
BACKGROUND Bariatric ( weight loss ) surgery for obesity is considered when other treatments have failed .
The effects of the available bariatric procedures compared with medical management and with each other are uncertain .
This is an up date of a Cochrane review first published in 2003 and most recently up date d in 2009 .
OBJECTIVES To assess the effects of bariatric surgery for overweight and obesity , including the control of comorbidities .