Distal Gastric Bypass/Duodenal Switch Procedure, Roux-en-Y Gastric Bypass and Biliopancreatic Diversion in a Community Practice

Background: Hybrid procedures combining purely restrictive and purely malabsorptive components to achieve stable long-term weight reduction have evolved since the 1970s. In a solo surgical community-based practice over the period 1984-1997, three different hybrid procedures were utilized as primary operations in patients who had not had prior bariatric surgery. Methods: Restrospective comparison of 32 patients who underwent biliopancreatic diversion (BPD), 138 patients who underwent distal gastric bypass Roux-en-Y (RGB) and 105 patients undergoing distal gastric bypass/duodenal switch procedure (DS) with 2-4 year follow-up in 37 DS patients. Results: Height, initial weight and initial body mass index (BMI) were similar in the three groups. The DS patients were older. Mean BMI at 2 years fell from 49 to 29 kg/m2 in both DS and RGB. Mean percentage maximum preoperative weight lost was 40% in both the DS and RGB groups. Two-year mean percentage excess weight lost in DS was 78%, compared to 74% in RGB. There were no operative deaths and no ulcers in the DS group. Conclusion: DS is an important new option for primary treatment of morbid obesity. It can be performed safely, with up to 4 year follow-up showing stable weight loss.