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BPD-DS vs banded RYGB

BPD-DS betters banded RYGB for QoL

Two types of surgery are effective to improve quality of life and weight loss
DS surgery produced better results in the quality of life evaluations regarding 2 of 8 domains according to the SF-36 and sexual interest according to the M-A QoLQ II
Resolution of comorbidities was similar in both groups

A Brazilian study comparing the biliopancreatic diversion with duodenal switch (DS) and the banded Roux-en-Y gastric bypass (BRYGB) has reported that the two types of surgery are effective to improve quality of life and weight loss. However, DS surgery produced better results in the quality of life evaluations regarding 2 of 8 domains according to the SF-36, and sexual interest according to the M-A QoLQ II. The study, Impact on quality of life, weight loss and comorbidities: a study comparing the biliopancreatic diversion with duodenal switch and the banded Roux-en-Y gastric bypass. published in the Arquivos de Gastroenterologia and undertaken by a group from Hospital do Servidor Público Estadual, São Paulo, SP, Brazil, also reported that the resolution of comorbidities was similar in both groups.

The authors note that few studies have evaluated the results of different types of bariatric surgery using the Medical Outcome Study 36 - Health Survey Short-Form (SF-36) quality of life questionnaire, the Bariatric and Reporting Outcome System (BAROS) and the reviewed Moorehead-Ardelt Quality of Life II Questionnaire (M-A QoLQ II) that is part of BAROS.

The aim of this study was to evaluate the impact of these two types of bariatric surgery on quality of life, comorbidities and weight loss. The DS group consisted of 17 patients and the BRYGB group consisted of 20. The control group comprised 20 independent, morbidly obese individuals.

This retrospective, longitudinal and non-randomised study covered all the patients that had surgery between February 2008 and August 2009 and that agreed to take part in the survey. The control group consisted of patients referred by the endocrinology team to the Bariatric Surgery Unit of the Hospital. The evaluations were conducted in 2010.

Outcomes

The mean age of the patients was 45.18 in the DS group, 49.75 in the BRYGB group and 44.25 in the C group, and was not statistically significant (p=0.1390). 82.5% of the patients were women and 17.5% were men. The respective ratios of women in the groups were 21.1% in the DS group, 29.8% in the BRYGB group, and 31.6% in the C group.

The average preoperative weight of the patients that underwent DS and BRYGB was 138.80kg and 121.65kg respectively and at the end of the study, it was 80.12kg and 73.40kg, respectively. The equated to an average percentage EWL in the DS and BRYGB groups of 82.1% and 89.4%, respectively, which was not significant (p=0.376801).

The analysis of the SF-36 questionnaire revealed that the control group had the worst results in all the evaluated domains in relation to the groups that had surgery and the DS group produced significantly better quality of life results than the BRYGB group regarding general state of health and pain.

The analysis of the M-A QoL II tool results revealed that the control group had a worse quality of life than the surgical groups on all counts, and the DS group showed a significant difference vs the BRYGB group regarding sexual interest. The final score of the BAROS protocol for the DS and BRYGB groups was 7.39±1.38 and 6.57±1.03 respectively, which put the surgical outcome of the DS group in the ‘excellent’ category and the BRYGB group in the ‘very good’ category, which was significantly different (p=0.044282*), in favour of the DS group.

“Comparing the two different types of surgery, the DS group patients showed better results for the general state of health and pain scales, which tends to indicate, respectively, an improvement in patient perception of his/her own health and expectations about the future, as well as an improvement in current pain and its intensity,” the authors write. “…a comparison among the three groups showed a significant improvement in the quality of life areas covered by the M-A QoLQ II of the patients who had surgery in relation to the control group. Comparing the surgical groups, the DS patients showed better results for the sexual interest item. The significant improvement of the sexual interest of the patients - mainly women - submitted to the DS technique appears to be in line with the significant results concerning patient perception of improved health and pain.”

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