Those who are significantly overweight suffer from a host of life-threatening, obesity related health conditions, referred to as co-morbidities. The most common of these include Type 2 diabetes mellitus (adult onset diabetes), high blood pressure, and high cholesterol. The higher an individual's body mass index (BMI), the more prevalent and severe these co-morbidities become. The "super obese" those with a BMI over 50 are at particularly high risk. Achieving sustained weight loss as well as resolving related health conditions are the two main objectives of weight loss surgery at our San Francisco practice.
Options for the Super Obese
Gastric bypass surgery (Roux-en-Y) is the traditional surgical approach to helping the super obese reduce their BMI and eliminate related health conditions. In recent years, however, studies have shown the duodenal switch procedure to be more effective both in terms of weight loss and in resolving co-morbidities, particularly for the super obese.
Pacific Laparoscopy has pioneered the laparoscopic duodenal switch procedure, which combines the benefits of both restrictive and malabsorptive procedures. The stomach is made smaller and part of the small intestine is bypassed. However, by keeping the pyloric valve intact, and retaining part of the duodenum, this procedure maximizes the digestion of food by the stomach and minimizes nutrient loss.
Traditional gastric bypass surgery bypasses the pyloric valve and the duodenum and connects the stomach directly to the small intestine. While both duodenal switch and gastric bypass result in significant weight loss and resolution of related health concerns, recent data indicates that independent of weight loss duodenal switch surgery produces a marked increase in the rate of resolution of co-morbidities.
Evidence Supports Duodenal Switch
In an extensive 3 year post-operative study of 350 super obese weight loss surgery patients, Vivek N. Prachand, MD, assistant professor of surgery at the University of Chicago Medical Center in Illinois, compared gastric bypass to duodenal switch (DS) in terms of how effectively each resolved several life-threatening health conditions. Of the participants, 198 were DS patients and 152 were gastric bypass patients. The study found the following rates of co-morbidity resolution:
Diabetes 100% of DS patients compared to 60% of gastric bypass patients
High blood pressure 68% of DS patients compared to 38% of gastric bypass patients
High cholesterol 72% of DS patients compared to 26% of gastric bypass patients
Remarkably, the rate of resolution correlated to the procedure type, rather than the amount of weight the patient lost. Regardless of weight loss, those in the DS group resolved these health problems at a significantly higher rate than those in the gastric bypass group.
There are several theories as to why duodenal switch resolves obesity related health concerns more effectively than other weight loss surgeries, but no clear answers. One factor may be that the unique gastrointestinal configuration used in the duodenal switch procedure preserves more natural digestive functioning. Other theories have to do with the causes of obesity and how the endocrine system is affected by each procedure.
What the Future Holds
These recent findings have provided some answers and brought about many more questions. While research will continue into the many complexities of this issue, mounting evidence supports duodenal switch as an effective alternative to gastric bypass for the super obese.