Discussion
obesity, gastrointestinal symptoms, weight gain, malnutrition, small bowel perforation, weight loss
OBESITY, HYPOALBUMINEMIA, BOWEL PERFORATIONS, ADVERSE EVENTS, ADVERSE EFFECTS, PERFORATED DIVERTICULITIS, MALNUTRITION, SMALL BOWEL PERFORATION, COMPLICATIONS
This is the first randomized study with follow-up data beyond 10 years comparing RYGB and BPD/DS in patients with super obesity. We could demonstrate that BPD/DS resulted in a sustained superior weight loss, better metabolic control and a superior BAROS score, however, at the cost of a higher rate of nutritional and surgical adverse events.Superior short-term weight loss in BPD/DS vs. RYGB has been demonstrated in other randomized and non-randomized studies [BPD/DS patients suffered from more adverse effects with an average of 2.7 issues per patient compared to 0.9 with RYGB. Some of the complications were considered severe with one patient requiring reversal surgery due to resistant hypoalbuminemia, two patients requiring emergency surgery due to small bowel perforation and one patient requiring emergency surgery due to perforated diverticulitis. The exact etiology to the bowel perforations is hard to establish, but in one of the small bowel perforations, malnutrition appeared to be a contributing factor. A higher number of consequent surgeries was seen for BPD/DS (0.9 vs. 0.3 surgeries per patient) with cholecystectomy being the most common but failed to reach statistical significance. The increased number of cholecystectomies is presumably due to a combination of higher weight loss and reduced bile re-absorption in BPD/DS. Performing a routine simultaneous cholecystectomy during BPD/DS has been subject to debate, some surgeons have performed it based on surgical judgment while others find it unnecessary [Regarding quality of life, the result was similar between the groups even though the BPD/DS group suffered from more adverse effects and gastrointestinal symptoms. We, however, report rather low quality of life scores compared to other studies [As expected, the BPD/DS group had superior glucose hemostasis as seen in other studies [BAROS is a well-established tool [The multiple benefits of BPD/DS outlined above must be weighed against the increased risk of complications and the need for a rigorous follow-up regimen. Some complications are severe and further consume a significant amount of health-care resources aside for patient morbidity. However, relapse of comorbidities and weight gain are as well very problematic as it creates health-related problems further on in life, reducing life expectancy [