Randomized clinical trial of laparoscopic gastric bypass versus laparoscopic duodenal switch for superobesity

Background: Laparoscopic Roux-en- gastric bypass (LRYGB) and laparoscopic biliopancreatic diversion with duodenal switch (LDS) are surgical options for superobesity. A randomized trial was conducted to evaluate perioperative (30-day) safety and 1-year results. Methods: Sixty patients with a body mass index (BMI) of 50–60 kg/m2 were randomized to LRYGB or LDS. BMI, percentage of excess BMI lost, complications and readmissions were compared between groups. Results: Patient characteristics were similar in the two groups. Mean operating time was 91 min for LRYGB and 206 min for LDS (P < 0·001). One LDS was converted to open surgery. Early complications occurred in four patients undergoing LRYGB and seven having LDS (P = 0·327), with no deaths. Median stay was 2 days after LRYGB and 4 days after LDS (P < 0·001). Four and nine patients respectively had late complications (P = 0·121). Mean BMI at 1 year decreased from 54·8 to 38·5 kg/m2 after LRYGB and from 55·2 to 32·5 kg/m2 after LDS; percentage of excess BMI lost was greater after LDS (74·8 versus 54·4 per cent; P < 0·001). Conclusion: LRYGB and LDS can be performed with comparable perioperative safety in superobese patients. LDS provides greater weight loss in the first year. Registration number: NCT00327912 (http://www.clinicaltrials.gov). Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.