The gastric bypass is the best surgical procedure for people with extreme obesity, according to a new analysis.
Researchers say an alternative procedure – the duodenal switch – has a greater risk of complications even though it is much more effective at cutting weight than the bypass.
The findings come from a study conducted over five years in Sweden and Norway.
Some 60 patients took part in the study, weighing on average 353 1bs or 25 stone (160kg).
Duodenal switch led to average weight losses of 146lbs- but some patients ended up back in hospital with malnutrition while others needed repeat operations, the doctors reported in JAMA Surg.
The gastric bypass achieved average weight losses of 901bs.
The duodenal switch involves removing a large part of the stomach and making changes to the small intestine while the gastric bypass simply bypasses the stomach.
Researcher Professor Torsten Olbers, of the Sahlgrenska Academy, University of Gothenburg, Sweden, said: "Despite the greater efficacy of duodenal switch when it comes to weight reduction, our findings suggest that it should be used with caution, given the higher percentage of long-term adverse effects."
Five-Year Outcomes After Laparoscopic Gastric Bypass and Laparoscopic Duodenal Switch in Patients With Body Mass Index of 50 to 60: A Randomized Clinical Trial. JAMA Surg 4 February 2015; doi: 10.1001/jamasurg.2014.3579
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