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Osorio J, Admella V, Merino D, Sobrino L, Tuero C, Vilarrasa N, Lazzara C. One-Stage Vs. Two-Step One Anastomosis Duodenal Switch (OADS/SADI-S): A Safety and Efficacy Single-Center Propensity-Score Matched Analysis. Obes Surg 2024; 34:2293-2302. [PMID: 38758514 DOI: 10.1007/s11695-024-07280-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/05/2024] [Accepted: 05/09/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION One Anastomosis Duodenal Switch (OADS/SADI-S) is used both as a one stage and a second-step procedure, either planned or revisional after a failed sleeve gastrectomy. However, there is lack of adjusted comparative evidence validating its use. MATERIAL AND METHODS Propensity-score matched comparison between patients submitted to one-stage vs. two-step OADS, adjusted by age, gender, and initial body mass index (BMI). RESULTS One hundred ninety-five patients (130 one-stage and 65 two-step OADS) were included, with mean initial BMI 52.4 kg/m2. Overall complication rate was 6.6% in the short-term (3.3% Clavien-Dindo ≥ III), and 7.3% in the long-term, with no differences between groups. Follow-up at 1 and 3 years was 83.6% and 61.5%. After one-stage OADS, total weight loss was 36.6 ± 8.2% at 1 year and 30.4 ± 10.3% at 3 years, vs. 30.2 ± 9.4% and 25.6 ± 10.2% after two-steps OADS (p = 0.021). Resolution rates of diabetes mellitus, hypertension, dyslipidemia, and obstructive sleep apnea were 86.4%, 80.4%, 78.0%, and 73.3%, with no differences between groups. CONCLUSION One-stage OADS is a safe and effective bariatric technique for patients with grade III and IV obesity. The two-step strategy does not reduce postoperative risks and may compromise weight loss results at mid-term.
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Affiliation(s)
- Javier Osorio
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, Carrer de La Feixa Llarga, S/N. 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Víctor Admella
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, Carrer de La Feixa Llarga, S/N. 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - David Merino
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, Carrer de La Feixa Llarga, S/N. 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lucía Sobrino
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, Carrer de La Feixa Llarga, S/N. 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Carlota Tuero
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, Carrer de La Feixa Llarga, S/N. 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Núria Vilarrasa
- Department of Endocrinology, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Claudio Lazzara
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, Carrer de La Feixa Llarga, S/N. 08907 L'Hospitalet de Llobregat, Barcelona, Spain
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Wisniowski P, Samakar K, Cheng V, Hawley L, Abel S, Nguyen J, Dobrowolsky A, Martin M. Safety of redo sleeve gastrectomy as a primary revisional procedure. Surg Obes Relat Dis 2024:S1550-7289(24)00172-2. [PMID: 38871494 DOI: 10.1016/j.soard.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 04/01/2024] [Accepted: 04/26/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Insufficient weight loss after primary laparoscopic sleeve gastrectomy (LSG) occasionally requires revisional surgery. A few single-institution studies have examined the safety of redo LSG (RSG) and have shown mixed results. OBJECTIVES The aim of this study was to evaluate the safety of RSG compared with LSG over a period of 30 days. SETTING University of Southern California, United States; Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. METHODS The 2020-2021 MBSAQIP registry was used to evaluate patients who underwent RSG. Thirty-day outcomes were evaluated using univariable analysis and multivariable logistic and linear regression. RESULTS A total of 226,029 patients were reviewed, of whom 1454 (.7%) underwent RSG and 224,575 (99.3%) underwent initial LSG. Patients who underwent RSG were older (45 versus 42 yr), predominantly female (86.2% versus 81.3%), had a lower body mass index (40.0 versus 43.4), fewer co-morbidities, and greater rates of gastroesophageal reflux (38.7% versus 25.1%). They demonstrated increased overall complications (3.6% versus 2.1%, P < .001) and a longer operative time (81 versus 62 min, P < .001), but there was no difference in mortality. On multivariable analysis, patients who underwent RSG were independently associated with an increased risk of overall postoperative complications (odds ratio [OR]: 1.493, P = .018), organ space infection (OR: 6.231, P < .001), staple line leak (OR: 12.838, P < .001), pneumonia (OR: 3.85, P = .013), ventilator requirement over 48 hours (OR: 6.404, P = .035), sepsis (OR: 4.397, P = .010), septic shock (OR: 8.669, P < .001), reoperation (OR: 1.808, P = .013), readmission (OR: 2.104, P < .001), reintervention (OR: 4.435, P < .001), and longer operative times (β = 12.790, P < .001). CONCLUSIONS In this national database study, RSG was associated with increased rates of postoperative complications and a longer operative time. Although these results are concerning, further studies are required to examine long-term outcomes.
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Affiliation(s)
- Paul Wisniowski
- Division of Upper GI and General Surgery, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, California.
| | - Kamran Samakar
- Division of Upper GI and General Surgery, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, California
| | - Vincent Cheng
- Department of Bariatric Surgery, Kaiser Permanente South Sacramento Medical Center, Sacramento, California
| | - Lauren Hawley
- Division of Upper GI and General Surgery, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, California
| | - Stuart Abel
- Division of Upper GI and General Surgery, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, California
| | - James Nguyen
- Division of Upper GI and General Surgery, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, California
| | - Adrian Dobrowolsky
- Division of Upper GI and General Surgery, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, California
| | - Matthew Martin
- Division of Upper GI and General Surgery, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, California
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Paccou J, Caiazzo R, Lespessailles E, Cortet B. Bariatric Surgery and Osteoporosis. Calcif Tissue Int 2022; 110:576-591. [PMID: 33403429 DOI: 10.1007/s00223-020-00798-w] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/14/2020] [Indexed: 02/06/2023]
Abstract
It has been increasingly acknowledged that bariatric surgery adversely affects skeletal health. After bariatric surgery, the extent of high-turnover bone loss is much greater than what would be expected in the absence of a severe skeletal insult. Patients also experience a significant deterioration in bone microarchitecture and strength. There is now a growing body of evidence that suggests an association between bariatric surgery and higher fracture risk. Although the mechanisms underlying the high-turnover bone loss and increase in fracture risk after bariatric surgery are not fully understood, many factors seem to be involved. The usual suspects are nutritional factors and mechanical unloading, and the roles of gut hormones, adipokines, and bone marrow adiposity should be investigated further. Roux-en-Y gastric bypass (RYGB) was once the most commonly performed bariatric procedure worldwide, but sleeve gastrectomy (SG) has now become the predominant bariatric procedure. Accumulating evidence suggests that RYGB is associated with a greater reduction in BMD, a greater increase in markers of bone turnover, and a higher risk of fracture than SG. These findings should be taken into consideration in determining the most appropriate bariatric procedure for patients, especially those at higher fracture risk. Before and after all bariatric procedures, sufficient calcium, vitamin D and protein intake, and adequate physical activity, are needed to counteract negative impacts on bone. There are no studies to date that have evaluated the effect of osteoporosis treatment on high-turnover bone loss after bariatric surgery. However, in patients with a diagnosis of osteoporosis, anti-resorptive agents may be considered.
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Affiliation(s)
- Julien Paccou
- Department of Rheumatology, MABLaB ULR 4490, CHU Lille, Univ. Lille, 59000, Lille, France.
- Department of Rheumatology, MABLaB ULR 4490, CHU Lille, 2, Avenue Oscar Lambret, 59037, Lille, France.
| | - Robert Caiazzo
- Inserm, Endocrine and Metabolic Surgery, UMR 1190, CHU Lille, Univ. Lille, 59000, Lille, France
| | - Eric Lespessailles
- Department of Rheumatology, CHR Orléans, I3MTO EA 4708, Univ. Orléans, 45067, Orléans, France
| | - Bernard Cortet
- Department of Rheumatology, MABLaB ULR 4490, CHU Lille, Univ. Lille, 59000, Lille, France
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Liagre A, Martini F, Kassir R, Juglard G, Hamid C, Boudrie H, Van Haverbeke O, Antolino L, Debs T, Petrucciani N. Is One Anastomosis Gastric Bypass with a Biliopancreatic Limb of 150 cm Effective in the Treatment of People with Severe Obesity with BMI > 50? Obes Surg 2021; 31:3966-3974. [PMID: 34176036 PMCID: PMC8397657 DOI: 10.1007/s11695-021-05499-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 01/23/2023]
Abstract
Purpose The treatment of people with severe obesity and BMI > 50 kg/m2 is challenging. The present study aims to evaluate the short and mid-term outcomes of one anastomosis gastric bypass (OAGB) with a biliopancreatic limb of 150 cm as a primary bariatric procedure to treat those people in a referral center for bariatric surgery. Material and Methods Data of patients who underwent OAGB for severe obesity with BMI > 50 kg/m2 between 2010 and 2017 were collected prospectively and analyzed retrospectively. Follow-up comprised clinical and biochemical assessment at 1, 3, 6, 12, 18, and 24 months postoperatively, and once a year thereafter. Results Overall, 245 patients underwent OAGB. Postoperative mortality was null, and early morbidity was observed in 14 (5.7%) patients. At 24 months, the percentage total weight loss (%TWL) was 43.2 ± 9, and percentage excess weight loss (%EWL) was 80 ± 15.7 (184 patients). At 60 months, %TWL was 41.9 ± 10.2, and %EWL was 78.1 ± 18.3 (79 patients). Conversion to Roux-en-Y gastric bypass was needed in three (1.2%) patients for reflux resistant to medical treatment. Six patients (2.4%) had reoperation for an internal hernia during follow-up. Anastomotic ulcers occurred in three (1.2%) patients. Only two patients (0.8%) underwent a second bariatric surgery for insufficient weight loss. Conclusion OAGB with a biliopancreatic limb of 150 cm is feasible and associated with sustained weight loss in the treatment of severe obesity with BMI > 50 kg/m2. Further randomized studies are needed to compare OAGB with other bariatric procedures in this setting. Graphical abstract ![]()
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Affiliation(s)
- Arnaud Liagre
- Ramsay Générale de Santé, Clinique des Cedres, Bariatric Surgery Unit, Cornebarrieu, France
| | - Francesco Martini
- Ramsay Générale de Santé, Clinique des Cedres, Bariatric Surgery Unit, Cornebarrieu, France
| | - Radwan Kassir
- Department of Digestive Surgery, CHU Félix Guyon, Saint Denis, La Réunion, France
| | - Gildas Juglard
- Ramsay Générale de Santé, Clinique des Cedres, Bariatric Surgery Unit, Cornebarrieu, France
| | - Celine Hamid
- Ramsay Générale de Santé, Clinique des Cedres, Bariatric Surgery Unit, Cornebarrieu, France
| | - Hubert Boudrie
- Ramsay Générale de Santé, Clinique des Cedres, Bariatric Surgery Unit, Cornebarrieu, France
| | - Olivier Van Haverbeke
- Ramsay Générale de Santé, Clinique des Cedres, Bariatric Surgery Unit, Cornebarrieu, France
| | - Laura Antolino
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St. Andrea Hospital, Sapienza University, Rome, Italy
| | - Tarek Debs
- Department of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
| | - Niccolo Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St. Andrea Hospital, Sapienza University, Rome, Italy.
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Godoy EPD, Pereira SSDS, Coelho D, Pinto IMDM, Luz VFD, Coutinho JL, Palitot TRDC, Costa HBDF, Campos JM, Brandt CT. Isolated intestinal transit bipartition: a new strategy for staged surgery in superobesity. ACTA ACUST UNITED AC 2019; 46:e20192264. [PMID: 31859724 DOI: 10.1590/0100-6991e-20192264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/15/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE biliopancreatic diversion with duodenal switch is a complex, malabsorptive procedure, associated with improved weight loss and metabolic control. Staged surgery with sleeve gastrectomy as the first stage is an option for reducing complications in superobese patients. However, some problems persist: large livers can hamper the surgical approach and complications such as leaks can be severe. Intestinal transit bipartition is a modified and simplified model of biliopancreatic diversion that complements sleeve gastrectomy. It is similar to the duodenal switch, but with less complexity and fewer nutritional consequences. This study assessed the feasibility and safety of isolated transit bipartition as the initial procedure in a two-step surgery to treat superobesity. METHODS this prospective study included 41 superobese patients, with mean BMI 54.5±3.5kg/m2. We performed a laparoscopic isolated transit bipartition as the first procedure in a new staged approach. We analyzed weight loss and complications during one year of follow-up. RESULTS we completed all the procedures by laparoscopy. After six months, the mean percent excess weight loss was 28%, remaining stable until the end of the study. There were no intraoperative difficulties. Half of the patients experienced early diarrhea, and three had marginal ulcers. There were no major surgical complications or deaths. CONCLUSION isolated laparoscopic transit bipartition is a new option for a staged approach in superobesity, which can provide a safer second procedure after effective weight loss over six months. It may be useful particularly in the management of patients with severe obesity.
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Affiliation(s)
- Eudes Paiva de Godoy
- Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Serviço de Cirurgia Geral, Natal, RN, Brasil
| | | | - Daniel Coelho
- Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Serviço de Cirurgia Geral, Natal, RN, Brasil
| | | | - Vinícius Fernando da Luz
- Universidade Federal do Rio Grande do Norte, Maternidade Escola Januário Cicco, Serviço de Anestesiologia, Natal, RN, Brasil
| | - Jorge Landivar Coutinho
- Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Serviço de Cirurgia Geral, Natal, RN, Brasil
| | | | - Hamilton Belo de França Costa
- Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Serviço de Cirurgia Geral, Natal, RN, Brasil
| | - Josemberg Marins Campos
- Universidade Federal de Pernambuco, Centro de Ciências da Saúde, Faculdade de Medicina, Departamento de Cirurgia, Recife, PE, Brasil
| | - Carlos Teixeira Brandt
- Universidade Federal de Pernambuco, Centro de Ciências da Saúde, Faculdade de Medicina, Departamento de Cirurgia, Recife, PE, Brasil
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Vilallonga R. Paired editorial: Long-term results (8 years) after sleeve gastrectomy. Surg Obes Relat Dis 2017; 13:1115-1116. [PMID: 28551373 DOI: 10.1016/j.soard.2017.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 04/05/2017] [Accepted: 04/06/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Ramon Vilallonga
- Vall d'Hebron Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
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Antanavicius G, Rezvani M, Sucandy I. One-stage robotically assisted laparoscopic biliopancreatic diversion with duodenal switch: analysis of 179 patients. Surg Obes Relat Dis 2015; 11:367-71. [DOI: 10.1016/j.soard.2014.10.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 09/03/2014] [Accepted: 10/26/2014] [Indexed: 10/24/2022]
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Is laparoscopic single-stage biliopancreatic diversion with duodenal switch safe in super morbidly obese patients? Surg Obes Relat Dis 2013; 10:427-30. [PMID: 24439116 DOI: 10.1016/j.soard.2013.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 10/06/2013] [Accepted: 10/08/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND It has been hypothesized that the morbidity and mortality of laparoscopic biliopancreatic diversion with duodenal switch (BPD-DS) are likely to increase with increasing body mass index (BMI), especially with BMI>50 kg/m(2). Therefore, a 2-stage approach to this procedure has been advocated in super morbidly obese patients. The authors hypothesized that a BMI ≥ 50 kg/m(2) does not significantly influence the morbidity and mortality perioperatively associated with this procedure. METHODS A retrospective analysis of all patients who underwent laparoscopic BPD-DS between January 2009 and September 2011 was performed. The patients were divided into 2 groups: patients with BMI<50 kg/m(2) and those with BMI>50 kg/m(2). Patient characteristics, perioperative variables, 30-day outcomes, and complications were analyzed and compared. RESULTS A total of 226 patients underwent laparoscopic BPD-DS. Mean patient age was 44.9 years (range: 20-72 yr). Male to female ratio was 59 to 170 patients (75% versus 25%), respectively. Mean BMI was 50.2 kg/m(2) (range: 37.2-68.8 kg/m(2)). A total of 127 patients had a BMI<50 kg/m(2) (Group 1), and 99 patients had a BMI ≥ 50 kg/m(2) (Group 2). The length of procedure in Groups 1 and 2 was 296 minutes and 287 minutes, respectively (P = .25). The rate of conversion to open BPD-DS was 1.5% in Group 1 and 3% in Group 2 (P = .65). Two leaks occurred in Group 1; no patient in Group 2 developed this complication. One patient in Group 2 developed pulmonary embolism. The rates of all other complications resulting in a longer length of stay were 11% in Group 1 and 8% in Group 2 (P = .50). The 30-day reoperation rate was 3% in Group 1 and 1% in Group 2 (P = .39). The mean length of stay was 3.97 days for Group 1 and 3.67 days for Group 2 (P = .34). No mortality occurred in this series. CONCLUSION In the present study, BMI ≥ 50 kg/m(2) did not increase intraoperative or postoperative complications at 30 days after laparoscopic PBD-DS. No significant differences were noted between patients with BMI ≥ 50 kg/m(2) and patients with BMI<50 kg/m(2). A single-stage laparoscopic BPD-DS procedure can be safely offered to the super morbidly obese patients.
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Affiliation(s)
- Rodney J Mason
- Department of Surgery, University of Southern California, 1100 North State Street, Room 6A231, Los Angeles, CA 90033, USA.
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Single-stage laparoscopic sleeve gastrectomy: safety and efficacy in the super-obese. J Surg Res 2012; 177:49-54. [DOI: 10.1016/j.jss.2012.01.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 12/16/2011] [Accepted: 01/04/2012] [Indexed: 01/07/2023]
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Topart P, Becouarn G, Ritz P. Weight loss is more sustained after biliopancreatic diversion with duodenal switch than Roux-en-Y gastric bypass in superobese patients. Surg Obes Relat Dis 2012; 9:526-30. [PMID: 22498360 DOI: 10.1016/j.soard.2012.02.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 12/22/2011] [Accepted: 02/24/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although biliopancreatic diversion with duodenal switch (BPD-DS) is not the most performed procedure, Roux-en-Y gastric bypass (RYGB) is challenged by weight regain and insufficient weight loss, especially in patients with a body mass index >50 kg/m(2). The aim of our retrospective study was to compare the weight loss after 2 types of primary bariatric surgery. A total of 83 BPD-DS and 97 RYGB procedures were performed from March 2002 to October 2009 for an initial mean body mass index of 55 kg/m(2). METHODS All RYGB patients underwent surgery at a private practice hospital and BPD-DS patients underwent surgery at a university hospital before February 2007 and at the same private hospital thereafter. The patients were seen in follow-up every 4 months the first year, every 6 months the second, and yearly thereafter. The maximum weight loss was assessed, as well as the weight regain beyond the first postoperative year. Weight loss success was defined as a percentage of excess weight loss (%EWL) of ≥50%. RESULTS The patients did not differ by age, gender, or length of follow-up (mean 46 mo, range .5-102 for RYGB and 44.3 mo, range 9-111 for BPD-DS). Of the patients, 17 RYGB and 7 BPD-DS patients were lost to follow-up within 3 years postoperatively. At 3 years of follow-up, the mean %EWL was 63.7% ± 17.0% after RYGB and 84.0% ± 14.5% after BPD-DS (P < .0001). Weight loss success was achieved by 83.5% of the RYGB and 98.7% of the BPD-DS patients (P = .0005). CONCLUSION After 12 months postoperatively, the number of patients regaining 10% of the weight lost during the first postoperative year was significantly greater after RYGB than after BPD-DS.
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Affiliation(s)
- Philippe Topart
- Société de Chirurgie viscérale, Clinique de l'Anjou, Angers, France.
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Iannelli A, Schneck AS, Topart P, Carles M, Hébuterne X, Gugenheim J. Laparoscopic sleeve gastrectomy followed by duodenal switch in selected patients versus single-stage duodenal switch for superobesity: case-control study. Surg Obes Relat Dis 2012; 9:531-8. [PMID: 22498357 DOI: 10.1016/j.soard.2012.02.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 01/15/2012] [Accepted: 02/15/2012] [Indexed: 01/06/2023]
Abstract
BACKGROUND The prevalence of superobesity (body mass index [BMI] ≥50 kg/m(2)) has increased steadily during the past decade, and the most suitable surgical strategy for these patients is still controversial. Our objective was to test the hypothesis that in selected superobese patients, laparoscopic sleeve gastrectomy (SG) followed by laparoscopic duodenal switch (DS) might reduce the rate of postoperative complications and the need for the second step duodenal switch. The setting was a university hospital in France. METHODS A retrospective analysis was performed of a prospective database of 110 consecutive patients with a BMI of ≥50 kg/m(2) undergoing the staged approach and matched for age, gender, and BMI with 110 consecutive patients undergoing single-stage DS. The excess weight loss (EWL), co-morbidity improvement, and incidence of postoperative complications were compared between the 2 groups. RESULTS One patient died in the staged strategy group (mortality rate .9%). The postoperative complication rate was 8.2% in the staged strategy group (110 patients) and 15.5% in the single-stage DS group (110 patients; P = 1). Multivariate analysis showed that single-stage DS surgery is the only variable significantly associated with the occurrence of postoperative complications (odds ratio 2.36; 95% confidence interval 1.001-5.61). In the staged strategy group, at a mean follow-up of 36.4 ± 13 months, 39 patients (35.5%) required the second-stage procedure. The mean %EWL was 50.8% ± 17.5% for SG alone (35% failed to maintain 50% EWL after SG), 61.5% ± 19.3% for the staged strategy, 72.7% ± 14.1% for 2-step DS (3.3% failed to maintain 50% EWL after 2-step DS), and 73.3% ± 17.6% for single-stage DS (7.3% failed to maintain 50% EWL after single-stage DS). CONCLUSIONS At 3 years of follow-up, staged DS surgery avoided biliopancreatic diversion in 72.7% of the patients. Single-stage DS increases the risk of postoperative complications but not of anastomotic leak.
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Affiliation(s)
- Antonio Iannelli
- Service de Chirurgie Digestive et Transplantation Hépatique, Pôle Digestif, Centre Hospitalier Universitaire de Nice, University of Nice Sophia-Antipolis, Nice, France.
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Dapri G, Cadière GB, Himpens J. Superobese and super-superobese patients: 2-step laparoscopic duodenal switch. Surg Obes Relat Dis 2011; 7:703-8. [PMID: 22014481 DOI: 10.1016/j.soard.2011.09.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 08/13/2011] [Accepted: 09/08/2011] [Indexed: 12/19/2022]
Abstract
BACKGROUND Morbidity and mortality after bariatric surgery in superobese (body mass index [BMI] >50 but <60 kg/m2) and super-superobese (BMI >60 kg/m2) patients can allegedly be reduced by performing surgery in 2 steps. We report a retrospective study gathered from a prospective database for superobese and super-superobese patients who underwent laparoscopic biliopancreatic diversion/duodenal switch (LBPD/DS) after laparoscopic sleeve gastrectomy (LSG) as the first step. METHODS From October 2004 to June 2010, 31 patients underwent LBPD/DS after LSG. The mean age was 45.8 ± 10.1 years (range 21-64). The mean interval between the 2 procedures was 13.9 ± 8.4 months (range 6-37). At LSG, the mean weight and BMI was 168.8 ± 35.4 kg (range 127-255) and 58.3 ± 6.7 kg/m2 (range 50-74.5). At LBPD/DS, the mean weight, BMI, and percentage of excess weight loss was 136.3 ± 32.6 kg (range 92-220), 47.1 ± 7.2 kg/m(2) (range 37.8-64.3), and 31.6% ± 12.2% (range -11.7 to +54.6). At LSG, 26 patients had 43 obesity co-morbidities. Three co-morbidities (6.9%) resolved in 3 patients before the second step of LBPD/DS was performed. RESULTS The mean operative time was 175.5 ± 60.6 minutes (range 75-285). There were no deaths or conversions to open surgery. Four patients had early complications (1 anastomotic leak, 1 small bowel perforation, 1 case of renal insufficiency, and 1 case of pneumonia). The mean hospital stay was 6.6 ± 8 days (range 3-35). All patients, with the exception of 3, were followed up for a mean of 28.8 ± 21.4 months (range 4-71). At follow-up, the mean weight, BMI, and percentage of excess weight loss (compared with the pre-LSG weight) was 99.4 ± 23.7 kg (range 62-150), 34.5 ± 5.8 kg/m2 (range 24.9-46.3), and 54.8% ± 16% (range 18.9-84.8). A total of 22 obesity co-morbidities (51.1%) resolved in 14 patients. Three patients presented with late complications (1 ventral hernia, 1 case of protein deficiency, 1 anastomotic stenosis). CONCLUSION In the treatment of superobese and super-superobese patients with 2-step LBPD/DS, we experienced no deaths and achieved acceptable morbidity, considering the high operative risk in this group. This procedure is effective for both weight loss and resolution of co-morbidities.
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Affiliation(s)
- Giovanni Dapri
- Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium.
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Topart P, Becouarn G, Salle A. Five-year follow-up after biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis 2010; 7:199-205. [PMID: 21237723 DOI: 10.1016/j.soard.2010.10.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 07/30/2010] [Accepted: 10/29/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Only limited data are available for assessing the medium and long-term outcomes after bariatric surgery. We report our own long-term results after biliopancreatic diversion with duodenal switch (BPD-DS). METHODS The data from 51 patients with a theoretical ≥5-year follow-up were reviewed after BPD-DS performed from February 2002 to October 2004. The patients were assessed every 3 months during their first postoperative year, every 6 months during the second year, and annually thereafter. RESULTS The preoperative body mass index (BMI) was 47 ± 6.1 kg/m(2). The first 23 patients had undergone open BPD-DS. The same procedure was used (150-mL sleeve, 150-cm alimentary limb, and 100-cm common channel) for the 28 laparoscopic BPD-DS procedures, although 15 patients underwent conversion to laparotomy at the beginning of our experience. No patients died postoperatively. Of the 51 patients, 7 were not available for follow-up: 2 patients had died 9 months after BPD-DS (1 of myocardial infarction and 1 after ventral hernia repair), 1 underwent reversal, 1 refused follow-up after a complicated postoperative course, and contact was lost with 3 patients (7.8% lost to follow-up). The 5-year BMI was 31 ± 4.5 kg/m(2), with a mean excess weight loss of 71.9% ± 20.6%. Of the 44 patients, 7 (15.9%) had an excess weight loss of <50%; 4 of these unsatisfactory results occurred after revision BPD-DS. After primary BPD-DS, excess weight loss of 75.8% ± 18.0% was observed. Biologic data were obtained for 85% of the patients at 5 years. The main vitamin and micronutrients parameters remained stable over time. However, a trend was seen toward an increase in the parathormone levels and difficulties in maintaining a normal vitamin D level despite updated vitamin supplementation. CONCLUSION The results of our study have shown that BPD-DS achieves sustainable significant weight loss with >5 years of follow-up, with unsatisfactory results in <20% of cases. Although not statistically significant, revision surgery more often resulted in lesser weight loss, although this difference had almost vanished when the initial BMI was taken as a reference compared with the BMI before BPD-DS.
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Affiliation(s)
- Philippe Topart
- Société de Chirurgie Viscérale, Clinique de l'Anjou, Angers, France.
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