"A less common form of obesity surgery may spur more weight loss than its far more popular cousin gastric bypass  but at the price of greater longterm risks researchers reported Tuesday.  The study published in the Annals of Internal Medicine followed  severely obese patients who were randomly assigned to either gastric bypass surgery or a more extensive procedure known as duodenal switch.  Two years after surgery duodenal switch patients had lost more weight about  pounds more on average.  People shed a substantial amount of weight with either type of surgery. Gastric bypass patients cut an average of  pounds while duodenal switch patients dropped about .  But those extra pounds came with nearly double the complication rate.  Of the  duodenal switch patients  percent had problems like abdominal pain vomiting diarrhea and intestinal obstruction. And several suffered longterm malnutrition  something not seen in the gastric bypass group.  Duodenal switch is not a popular procedure. In a  study it accounted for just  percent of weightloss or bariatric surgeries done in the U.S. and  percent in Europe.  The technique is often reserved for superobese patients with a body mass index BMI of  or higher  though some surgeons perform it with less severely obese patients too explained Dr. Torgeir T. Sovik of Oslo University in Norway the lead researcher on the new study.  As duodenal switch can be associated with more adverse events this procedure should only be performed in carefully selected patients by a dedicated bariatric team Sovik told Reuters Health in an email. And a closer followup after surgery is required after such procedures.  But an expert not involved in the study went further.  This is an operation that should probably go away said Dr. Edward H. Livingston a professor and surgeon at the University of Texas Southwestern Medical Center in Dallas.  The average weight loss seen with either gastric bypass or duodenal switch will improve or reverse obesityrelated ills like diabetes sleep apnea and knee arthritis according to Livingston who wrote an editorial published with the study.  So for those medical conditions it probably wouldnt matter if a person lost  pounds or  pounds over two years.  Sponsored BMI is a measure of weight relative to height. A BMI between . and . is considered normal weight and above  is obese.  The patients in the current study were a fairly healthy group despite having a BMI of  or more.  After two years those whod had a duodenal switch showed a greater improvement in their cholesterol levels. But those levels were nearnormal in both groups to begin with Livingston noted.  That begs the question he said of whether the extra weight loss actually accomplished anything.  The answer is no Livingston said.  In the U.S. where about  people underwent weightloss surgery in  gastric bypass is the most common form chosen.  During gastric bypass the upper portion of the stomach is stapled off to create a smaller pouch that restricts the amount of food a person can eat at one time. The surgeon also creates a bypass around the rest of the stomach and a portion of the small intestine which limits the bodys absorption of food.  Duodenal switch is more extensive. The surgeon removes part of the stomach and the remaining sleevelike stomach is attached to the final section of the small intestine that puts even greater limits on the bodys absorption of calories and nutrients.  Both surgeries carry the longterm risk of nutritional deficiencies and people need to take supplements and carefully monitor their diets for a lifetime afterward.  But the risks of nutrient deficiencies are greater with duodenal switch and include some not seen with gastric bypass Livingston pointed out.  Some people for instance may have severe calcium and vitamin D loss leading to weak and fragile bones. Other problems include severe protein deficiency and night blindness caused by vitamin A deficiency which is also reversible with extra vitamin A treatment.  In this study three of the  duodenal switch patients developed protein malnutrition two developed night blindness and one had a severe iron deficiency that needed to be treated with iron infusions.  Livingston said his advice to people considering weightloss surgery is to avoid duodenal switch. Its just not a good operation he asserted.  But he also questioned the value of weightloss surgery in general for severely obese people who do not have medical conditions that stand to improve or resolve after surgery.  In general experts say that surgery could be an option for anyone with a BMI of  or higher that translates roughly to a man who is at least  pounds overweight or a woman who is  pounds overweight.  Livingston said he thinks more caution is in order when a very obese person is otherwise healthy.  Along with the risks of surgery he said there is still uncertainty about whether it actually lengthens peoples lives. Some studies have suggested it might but not all.  In a study recently published in the Journal of the American Medical Association Livingston and his colleagues found no survival advantage among severely obese patients whod undergone weightloss surgery versus those who hadnt.  The study involved  U.S. veterans who underwent some form of weightloss surgery at an average age of about  and more than  vets who had only nonsurgical care. There was no evidence that surgery improved longevity over the next seven years.  We really dont even know if theres a survival benefit Livingston said.  That he added makes the risks of duodenal switch seem even less worthwhile.  But according to Sovik duodenal switch might be appropriate for some superobese patients.  In the U.S. he said about one in three weightloss surgery candidates have a BMI of  or higher. And studies suggest that a sizable percentage of those people will still have a BMI higher than  after gastric bypass.  In this study onequarter of gastric bypass patients still had a BMI that high two years after surgery  versus none of the duodenal switch patients.  More extensive monitoring after duodenal switch Sovik noted can help detect and manage side effects.  He pointed out though that larger longerterm studies are still needed to show whether the extra weight loss with duodenal switch ultimately improves severely obese patients health and extends their lives.  SOURCE bit.lymQAUrf httpbit.lymQAUrf Annals of Internal Medicine online September  . Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"