Duodenal Switch Surgery Riskier Than Gastric Bypass

The first randomized comparison of gastric bypass and duodenal switch surgery, published in the Annals of Internal Medicine, shows greater weight loss and improvements in cardiovascular risk factors with duodenal switch, but at the expense of more adverse events.

Two years after gastric bypass or duodenal switch was performed on some 60 patients with superobesity (BMI, 50 to 60), most cardiovascular risk factors improved in both groups. Duodenal switch patients had greater weight loss than bypass patients (mean loss, 74 vs. 51 kg), as well as greater reductions in total and LDL cholesterol. However, they also had more adverse events (62% vs. 32%); in particular, malnutrition-related events such as night blindness, severe iron deficiency, and protein calorie deficiency occurred only after duodenal switch.

An editorialist notes that few patients had adverse cardiovascular profiles to begin with and concludes: "We should seriously question whether there is any role for the duodenal switch operation ... its complications are very real and very severe."