DS vs. RNY: Percentage of excess weight lost/maintained long-term

[Guest guest]

wrote:

> I have been told that you don't loose as much weight with a

> DS as with an RNY. Is that true?

I have never seen any evidence that this is true. Some people say that

RNY folks lose faster initially, which wouldn't surprise me given the

extreme restriction of the pouch. But I've seen DS patients lose darn

quick too. The initial rapid weight loss is such an individual thing,

and of course those who start out heavier will lose a greater amount of

weight in a shorter time initially, so that could skew our perception in

some way as well if we're looking at anecdotal data.

The real question is not how fast one loses how much, but how long how

much stays off. We have clinical data to show that the DS is unmatched

in percentage of excess weight kept off over the long term (5+ years).

Here are some cites on the issue of weight regain following DS:

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1.) From Dr. Baltasar, a surgeon with many years of experience in all

forms of WLS, reporting on 125 patients at the five-year mark:

http://www.duodenalswitch.com/Procedure/baltasar.pdf

" Duodenal Switch: an Effective Therapy for Morbid Obesity —

Intermediate Results. " Obes Surg. 2001 Feb;11:54-59

" BPD-DS is the most effective operation to lose weight. Hess had

a %EWL of 80 at 2 years and 70 at 8 years. Marceau had a 73% EWL

at 4.5 years, and 87% of his patients had a %EWL >50; 81% of his

patients had a BMI <35 and only 6% had a BMI >40. In our intermediate

experience, %EWL exceeded the 70% throughout the years, and only 3

patients did not reach 50% EWL. Comparing morbid and super obesity,

%EWL was superior in the morbidly obese but the fall in BMI was

greater in the super obese. The mean fall in BMI was 37% in the

morbidly obese and 43% in the super obese. Marceau found the nadir

of weight loss at 53 ± 20 kg, and the weight gain was 7 kg after

several years. We have had no conversions in our patients thus

far due to poor weight loss.

2.) From Dr. Hess, reporting on his first 440 DS patients at the

eight-year mark.

(See the second " RESULTS " link in the index on the page referenced below

for more details):

http://www.duodenalswitch.com/Procedure/1998Hess/1998hess.html

Hess, et al.: Biliopancreatic Diversion with a Duodenal Switch,

Obesity Surgery, 8, 1998; 267-282.

" Of the long term results, there is a only small amount of regain

and we have never had a patient regain weight up to their original

weight. "

3.) Rabkin reported a mean %EWL in his DS patients of 73% at the

four-year mark. At the two-year mark, these patients had been at 78%

EWL. If we extrapolate those numbers to assume a 5% regain from the

nadir, these numbers are consistent with the other DS studies which show

only a small amount of regain after the " opportunity window " closes.

(If this link breaks to two lines, you'll need to cut and paste to get

the entire URL into your browser's address field):

http://www.pacificsurgery.com/For_Physicans/Clinical_Data/clinical_data.

html

(Rabkin RA. “Distal gastric bypass/duodenal switch procedure, Roux-en-Y

gastric bypass and biliopancreatic diversion in a community practice.”

Obes Surg. 1998 Feb;8(1):53-9.44).

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I don't know of any RNY studies that report results out to four years

and beyond that are comparable to the DS with regard to %EWL and

maintained. Shorter-term RNY studies have shown comparable results to

the DS, but the numbers get more dissimilar the further post-op they get

-- which presumably means that RNY patients are regaining at a greater

rate than DS patients.

It has been awhile since I've been involved in any lengthy " DS vs. RNY "

debate, but last time I was in such a debate, we couldn't find any RNY

studies that reported results further out than the 2-year point. There

was one study that was a far out as 4 years, but that showed mediocre

results for the RNY.

M.

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in Valrico, FL, age 38

Starting weight 299, now 156

Starting BMI 49.7, now 26.0

Lap DGB/DS by Dr. Rabkin 10-19-99

http://www.duodenalswitch.com

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