Strengths and Limitations
obesity, death, Weight loss, hernias, weight loss, comorbid diseases
OBESITY, DISEASE, BARIATRIC SURGERY CANDIDATE, REMISSION, PREMATURE, COMPLICATIONS
This is the first randomized study comparing RYGB and BPD/DS with follow-up data extending beyond 10 years. Despite the rather small number of patients, we could verify the expected benefits of the two procedures and establish the long-term superiority of BPD/DS concerning BAROS score, weight loss, glucose homeostasis, and HbA1c, at the cost of more complications. However, the small number of patients could make the study under-powered in finding statistical significance for some trends that were noted. Premature closure of inclusion to the study was due to the increasing numbers of patients declining randomization in favor of BPD/DS. Among other potential limitations, the remission of comorbid diseases is somewhat crude as it is based on the use of pharmacological therapy and not exact diagnostic criteria for each disease. We did unfortunately not have access to vitamin and mineral status, nor the cause of death for some of the deceased patients. Weight loss was self-reported which might underestimate the weight at follow-up. However, in a study of 179 overweight bariatric surgery candidates, the BMI misestimation was only negative 0.59% BMI and did not show statistical significance [Moreover, the use of open surgery, standard at our center for patients with super obesity at the time of randomization (2004–2007) explains the rather large number of incisional hernias, while laparoscopic approach, with its well established advantages [