Comparison of 2-Year Results of Roux-en-Y Gastric Bypass and Transit Bipartition with Sleeve Gastrectomy for Superobesity

May 18, 2020Obesity surgery

Two-Year Outcomes of Two Weight-Loss Surgeries Compared to Sleeve Gastrectomy for Extreme Obesity

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Abstract

Weight loss after transit bipartition (TB) was significantly greater, with a percentage of excess BMI lost (%EBMIL) of 85.3 ± 15.8% compared to 73.9 ± 17.2% for Roux-en-Y gastric bypass (RYGB).

Both RYGB and TB groups had similar age and BMI, averaging around 51.9 kg/m² for RYGB and 51.6 kg/m² for TB.
TB surgery took longer to perform than RYGB, averaging 92 minutes versus 74 minutes.
The 30-day complication rates were 4.2% for TB and 5.6% for RYGB, with one death occurring after RYGB.
One patient after TB experienced protein malnutrition, while no such cases were reported after RYGB.
Patients undergoing TB reported a higher incidence of digestive side effects, with 7% experiencing more than 3 stools per day.

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PURPOSE: Although Roux-en-Y gastric bypass is a powerful procedure, achieving and maintaining significant weight loss remains challenging in superobese populations. Transit bipartition with sleeve gastrectomy is derived from biliopancreatic diversion with duodenal switch and might improve weight loss control.

MATERIALS AND METHODS: Two series of 71 primary laparoscopic Roux-en-Y gastric bypass (RYGB) and transit bipartition (TB) with a body mass index ≥ 50 kg/mwere retrospectively compared after 2 years. Postoperative course, side effects, nutritional status, and weight outcomes were reviewed. Weight was expressed as BMI, percentage of excess BMI lost (%EBMIL), and percentage of total weight lost (%TWL). 2

RESULTS: The 2 groups were comparable for age and BMI of 51.9 ± 1.8 for RYGB and 51.6 ± 5 for TB. TB was longer to perform (92 vs 74 min, p ≤ 0.001) with a 30-day complication rate of 4.2% and 5.6%, but there was 1 death after RYGB. Weight loss was greater after TB compared with RYGB with %EBMIL of 85.3 ± 15.8% vs 73.9 ± 17.2% (p = 0.0002). One TB patient suffered from protein malnutrition but none after RYGB. After TB, 7% of the patients experienced > 3 stools a day and 1 patient required revision, while 3 patients had diarrhea after RYGB. Late reoperations were required for 7 and 1 patients after RYGB and TB. Comorbidity improvement was similar.

CONCLUSION: In a superobese population, TB appeared relatively safer compared with RYGB. It achieved a better weight loss at 2 years with a trend for more digestive side effects.

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Comparison of 2-Year Results of Roux-en-Y Gastric Bypass and Transit Bipartition with Sleeve Gastrectomy for Superobesity

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