Long-Term Results of a Prospective Comparison of Roux-en-Y Gastric Bypass versus a Variant of Biliopancreatic Diversion in a Non-Superobese Population (BMI 35–50 kg/m²)

This study presents late results of a previously published 2-year prospective comparison between Roux-en-Y gastric bypass (RYGBP) versus biliopancreatic diversion with Roux-en-Y gastric bypass (BPD-RYGBP) in an exclusively non-superobese population.

From a cohort of 130 patients with a BMI of 35–50 kg/m², 65 were randomly selected to undergo RYGBP and 65 to BPD-RYGBP. All underwent follow-up evaluation at 1, 3, 6, and 12 months postoperatively and every year thereafter.

Follow-up at the eighth year was achieved in 60 % of the BPD-RYGBP and in 58 % of the RYGBP group (p = 1.00). Mean excess weight loss (EWL%), was significantly higher following BPD-RYGBP (76.89 ± 1.53) as compared to RYGBP (67.17 ± 1.43) (p = 0.0004). The mean success rate (percentage of patients with EWL% ≥50 %) was significantly higher after BPD-RYGBP (95.85 ± 1.01) than RYGBP (75.91 ± 3.58) (p = 0.0001). No significant differences were observed for late non-metabolic complications. The incidence of anemia, iron deficiency, B₁₂ deficiency, and low-ferritin levels was relatively high in both groups with not always significant differences. Severe protein malnutrition occurred in four patients (three BPD-RYGBP and one RYGBP) (p = 0.37). In only one BPD-RYGBP patient (1.54 %) was revision surgery to RYGBP necessary, due to recurrent episodes of hypoproteinemia. The remaining patients were treated successfully with total parenteral nutrition and nutritional counseling.

Late results presented in this paper agree with the previously published 2-year results of the same patient cohort. Although both procedures are safe and effective, BPD-RYGBP seems to prevail in terms of successful weight loss without a significantly higher incidence of metabolic and non-metabolic complications.