Loop duodenal switch confers more complications with little gain of weight loss compared to Roux-en-Y gastric bypass

Background: There are several surgical options each with their potential for complications, differences in length of procedure, and in meaningful outcomes. This study aims to explore those outcomes after Roux-en-Y Gastric Bypass (RYGB) and Loop Duodenal Switch (LDS).

Objective: The purpose of this project is to offer a comparative analysis of RYGB and LDS at the NorthShore University Health System for up to 4 years postoperatively.

Methods: A retrospective review of a prospectively maintained database was queried for all patients who underwent RYGB and LDS from 2019 to 2023. Demographic, preoperative, post-operative data, and Quality of Life (QOL) data were included. χ² and Kruskal-Wallis tests were used for comparison. Statistical significance was set at p < 0.05.

Results: Patient database included 238 patients who underwent RYGB, and 54 who underwent LDS. Initial BMI was significantly higher in LDS compared to RYGB (56.9 ± 8.0; 46.5 ± 7.3; p < 0.01). There were no statistically significant differences between reported comorbidities. There were no differences in intraoperative complications between the two groups, however postoperative complications were significantly higher in the LDS population (16.7%, 7.1%; p < 0.01). Percent total body weight loss (%TBWL) was significantly different at 2 years post operatively with LDS having more %TBWL than RYGB (LDS: N = 10, %TBWL = 44.7 ± 14.1%; RYGB: N = 47) There were no statistically significant differences at any other postoperative time point. Subgroup analysis was completed in patients with initial BMI 50. There were no significant differences at any postoperative time point. QOL data showed no significant difference between both procedures at all postoperative timepoints.

Conclusion: Patients who undergo LDS are more likely to experience postoperative complications compared to RYGB with no added benefit in weight loss or comorbidity resolution up to 3 years post operatively.