Duodenal Switch Surgery Better Against Type 2 Diabetes Than Gastric Bypass

Over the years, gastric bypass surgery has proven an effective means of controlling-and even reversing-type 2 diabetes in
"super-obese" patients (those with a body mass index of 50 or above; usually more than 200 pounds above ideal body weight).

But now University of Chicago researchers have concluded that another type of surgery, called a duodenal switch, is even more effective at controlling such obesity-related conditions as diabetes, high cholesterol, and high blood pressure.

In gastric bypass surgery, surgeons create a small pouch that is separated from the rest of the stomach. Food bypasses the stomach, instead going through the pouch. The smaller size and capacity of the pouch lessens appetite and reduces the amount of food that the body can digest at any one time.

In contrast, duodenal switch surgery modifies the stomach itself, reshaping it into a long, narrow tube. At the same time, the small intestine is changed to reduce the amount of calories it can absorb.

Following either surgery, many obese patients are able to cease taking the medications used to treat their conditions. After tracking the results of the two types of surgery on 350 super-obese patients, however, the researchers noted that the duodenal switch had decisively better postoperative outcomes than the gastric bypass.

• One hundred percent of duodenal switch patients completely stopped taking their diabetes medications, versus 60 percent of gastric bypass patients.
• Sixty-eight percent of duodenal switch patients completely stopped taking their hypertension medications, versus 38.6 percent of gastric bypass patient
• Seventy-two percent of duodenal switch patients completely stopped taking their medications for high cholesterol, versus 26 percent of gastric bypass patients

However, one area in which the gastric bypass outperformed the duodenal switch was in the resolution of acid reflux disease. Almost 77 percent of gastric bypass patients enjoyed a cessation of the disease, versus 48.5 percent of patients undergoing duodenal switch.

One drawback to the duodenal switch is potential vitamin deficiencies or even malnutrition brought on by the modification of the small intestine's ability to absorb nutrients. Because obese people often already have pre-operative nutritional deficiencies, the University of Chicago researchers say that duodenal switch patients may routinely require vitamin supplementation. 

Results of the study were presented recently at Digestive Disease Week® 2009 in Chicago.