"I personally agree" with Romy et al. that Roux-en-Y gastric bypass is the better procedure, but "before we make from this conclusion a paradigm, a few caveats remain," said Dr. Jacques Himpens.
A case-control study such as this one may be biased. Even though a prospective randomized trial comparing the two surgeries isn’t feasible, a prospective rather than retrospective comparison of matched patients would yield better evidence, as would a multicenter rather than a single-center study.
In addition, a growing number of Roux-en-Y patients are showing neuroglycopenia and diabetes recurrence several years after surgery, which is concerning.
Dr. Himpens is at the European School of Laparoscopy at Saint Pierre University Hospital, Brussels. He reported being a consultant for Ethicon Endo-Surgery, Covidien, and Gore. These remarks were taken from his invited critique that accompanied Dr. Romy’s article (Arch. Surg. 2012 Jan. 16 [doi:10.1001/archsurg.2011.1855]).
FROM ARCHIVES OF SURGERY
No financial conflicts of interest were reported by the researchers.
