Is transit bipartition a better alternative to biliopancreatic diversion with duodenal switch for superobesity? Comparison of the early results of both procedures

Background: During the past years, 2 alternatives to the powerful but side-effect-prone biliopancreatic diversion with duodenal switch (BPD-DS) were developed: one-anastomosis duodenal switch (OADS) and sleeve gastrectomy with transit bipartition (TB). Objectives: To compare the 1-year results of TB and BPD-DS aiming at reducing the risk of protein malnutrition while keeping a similar weight loss for body mass index (BMI) >= 50 kg/m(2). Setting: Private hospital, single-surgeon practice in a bariatric surgery center. Methods: After a change in practice in 2017, the last 71 primary BPD-DS and the first 71 TB in patients with a BMI >= 50 kg/m(2) were retrospectively compared. Postoperative course, side effects, nutritional status, and need for revision and weight outcomes were reviewed. Weight was expressed as BMI, percentage of excess BMI lost, and percentage of total weight lost. Results: TB was faster to perform (92 versus 149 min, P < .0001) with a comparable 30-day complication rate of 4.3% and 5.7%. TB patients had a shorter hospital stay (2.3 +/- 1 versus 4.5 +/- 3.4 d, P < .0001). At 1 year, weight loss was significantly lower after TB compared with BPD-DS with percentage of excess BMI loss of 83.7 +/- 12.2% versus 78.6 +/- 14.7% (P = .0023). Two patients were lost to follow-up after BPD-DS and 6 after TB. Seven BPD-DS patients were treated for protein malnutrition, whereas only 2 patients had severe side effects after TB. Only 7% of the TB patients experienced >3 stools a day compared with 33% after BPD-DS (P = .016). There was no significant difference in terms of co-morbidity improvement at 1 year: 81.8% and 61.9% of patients had remission of blood hypertension, 9% and 14.3% had improvement, type 2 diabetes was in remission in 90% and 88%, and obstructive sleep apnea in 84% and 78% of the TB and BPD-DS patients, respectively. Conclusions: Although 1-year weight loss was significantly lower when BMI was >= 50, the real benefit of TB is the reduction of the side effects and protein malnutrition compared with BPD-DS. TB represents a much simpler alternative to BPD-DS for treating superobesity with less risk of major complications, but prospective studies and longer follow-up are required to confirm the maintenance of the weight loss in the long term. (C) 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.