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Sorribas M, Casajoana A, Sobrino L, Admella V, Osorio J, Pujol-Gebellí J. Experience in biliopancreatic diversion with duodenal switch: Results at 2, 5 and 10 years. Cir Esp 2022; 100:202-208. [PMID: 35431160 DOI: 10.1016/j.cireng.2022.03.015] [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: 11/04/2020] [Accepted: 01/15/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Duodenal switch (DS) is considered one of the most effective techniques to achieve weight loss and reduce comorbidities in patients with morbidly obesity. MATERIAL AND METHODS Descriptive single-center study. 224 patients were analyzed who underwent direct laparoscopic DS in our center. The objective was to describe the results of weight, resolution of comorbidities, nutritional supplementation and postoperative complications at 2, 5 and 10 years. RESULTS The mean age of the cohort was 49.3 [23-65] years and the mean weight and BMI were 131.8 [20] kg and 49.8 [5] kg/m2. The excess weight lost percentage at 2, 5 and 10 years was 80.6[15]%, 69.3[18]%, 67.4[18]%, respectively. Complete remission of diabetes was evidenced at 2 and 5 years in 35 (85.4%) and 27 (70.4%) patients. In the immediate postoperative period, the complication rate for Clavien-Dindo ≥ III was 15 patients (6.7%) and mortality at 30 and 90 days was 1 (0.4%) and 2 (0.9%) patients. Revisional surgery was performed in 2 patients (0.9%). 80% of the patients required an extra nutritional supplement up to 10 years after surgery. CONCLUSIONS Direct DS is a safe and effective technique in patients with a BMI between 45 and 55 kg/m2. Weight loss is maintained with a low rate of revision surgery. It is a metabolically effective technique that entails the need for a close postoperative follow-up to assess nutritional supplementation.
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Affiliation(s)
- Maria Sorribas
- Departamento de Cirugía General y Digestiva, Unidad de Cirugía Bariátrica y Metabólica, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Anna Casajoana
- Departamento de Cirugía General y Digestiva, Unidad de Cirugía Bariátrica y Metabólica, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Lucía Sobrino
- Departamento de Cirugía General y Digestiva, Unidad de Cirugía Bariátrica y Metabólica, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Víctor Admella
- Departamento de Cirugía General y Digestiva, Unidad de Cirugía Bariátrica y Metabólica, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Javier Osorio
- Departamento de Cirugía General y Digestiva, Unidad de Cirugía Bariátrica y Metabólica, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Pujol-Gebellí
- Departamento de Cirugía General y Digestiva, Unidad de Cirugía Bariátrica y Metabólica, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Surve A, Cottam D, Belnap L, Richards C, Medlin W. Long-Term (> 6 Years) Outcomes of Duodenal Switch (DS) Versus Single-Anastomosis Duodeno-Ileostomy with Sleeve Gastrectomy (SADI-S): a Matched Cohort Study. Obes Surg 2021; 31:5117-5126. [PMID: 34523085 DOI: 10.1007/s11695-021-05709-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND There are no comparative studies on the long-term outcomes after the primary traditional duodenal switch (DS) and single-anastomosis duodeno-ileostomy with sleeve gastrectomy (SADI-S). PURPOSE This study aims to compare the long-term outcomes in a matched cohort. SETTING This study took place in a single private institute, in the USA. MATERIALS AND METHODS Data from 266 patients who underwent a primary laparoscopic traditional DS or primary laparoscopic SADI-S from September 2011 to December 2015 by four surgeons were used for a retrospective matched cohort. Data were obtained by matching every DS patient to a SADI-S patient of the same age, sex, and body mass index (BMI). In addition, only patients that were out at least 5 years and had a minimum 5-year follow-up were included in the study. RESULTS The matched cohort included 30 DS and 30 SADI-S patients. There were no statistically significant differences in the preoperative characteristics and baseline comorbidities between both groups. The SADI-S patients had significantly shorter operative time and length of stay. The overall long-term complications, especially the long-term Clavien-Dindo grade IIIb complications, were significantly fewer with SADI-S. At 6 years, the DS patients had statistically higher %EWL; however, the ending BMIs were statistically similar between both groups. There were no significant differences in the long-term comorbidity and nutritional outcomes of both groups. The long-term failure rates were comparable. CONCLUSIONS Most long-term outcomes of SADI-S were either similar or significantly better than DS. Part of the reasons could be the surgeon's learning curve and the small sample sizes of both groups.
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Affiliation(s)
- Amit Surve
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Daniel Cottam
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA.
| | - Legrand Belnap
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Christina Richards
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Walter Medlin
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
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Sorribas M, Casajoana A, Sobrino L, Admella V, Osorio J, Pujol-Gebellí J. Experience in biliopancreatic diversion with duodenal switch: results at 2, 5 and 10 years. Cir Esp 2021; 100:S0009-739X(21)00030-0. [PMID: 33593597 DOI: 10.1016/j.ciresp.2021.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/17/2020] [Accepted: 01/15/2021] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Duodenal switch (DS) is considered one of the most effective techniques to achieve weight loss and reduce comorbidities in patients with morbidly obesity. MATERIAL AND METHODS Descriptive single-center study. 224 patients were analyzed who underwent direct laparoscopic DS in our center. The objective was to describe the results of weight, resolution of comorbidities, nutritional supplementation and postoperative complications at 2, 5 and 10 years. RESULTS The mean age of the cohort was 49.3 [23-65] years and the mean weight and BMI were 131.8 [20]kg and 49.8 [5]kg/m2. The excess weight lost percentage at 2, 5 and 10 years was 80.6[15]%, 69.3[18]%, 67.4[18]%, respectively. Complete remission of diabetes was evidenced at 2 and 5 years in 35 (85.4%) and 27 (70.4%) patients. In the immediate postoperative period, the complication rate for Clavien-Dindo ≥ III was 15 patients (6.7%) and mortality at 30 and 90 days was 1 (0.4%) and 2 (0.9%) patients. Revisional surgery was performed in 2 patients (0.9%). 80% of the patients required an extra nutritional supplement up to 10 years after surgery. CONCLUSIONS Direct DS is a safe and effective technique in patients with a BMI between 45 and 55 kg/m2. Weight loss is maintained with a low rate of revision surgery. It is a metabolically effective technique that entails the need for a close postoperative follow-up to assess nutritional supplementation.
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Affiliation(s)
- Maria Sorribas
- Departamento de Cirugía General y Digestiva, Unidad de Cirugía Bariátrica y Metabólica, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Anna Casajoana
- Departamento de Cirugía General y Digestiva, Unidad de Cirugía Bariátrica y Metabólica, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
| | - Lucía Sobrino
- Departamento de Cirugía General y Digestiva, Unidad de Cirugía Bariátrica y Metabólica, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Víctor Admella
- Departamento de Cirugía General y Digestiva, Unidad de Cirugía Bariátrica y Metabólica, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Javier Osorio
- Departamento de Cirugía General y Digestiva, Unidad de Cirugía Bariátrica y Metabólica, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Jordi Pujol-Gebellí
- Departamento de Cirugía General y Digestiva, Unidad de Cirugía Bariátrica y Metabólica, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
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A Matched Cohort Comparison of Long-term Outcomes of Roux-en-Y Gastric Bypass (RYGB) Versus Single-Anastomosis Duodeno-ileostomy with Sleeve Gastrectomy (SADI-S). Obes Surg 2020; 31:1438-1448. [PMID: 33201398 DOI: 10.1007/s11695-020-05131-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND The long-term effectiveness of Roux-en-Y gastric bypass (RYGB) and single-anastomosis duodeno-ileostomy with sleeve gastrectomy (SADI-S) is unknown. PURPOSE Compare the long-term outcomes. SETTING Single private institute, USA. MATERIALS AND METHODS Data from 1254 patients who underwent primary RYGB or SADI-S were used for a retrospective matched cohort. Data were obtained by matching every RYGB patient to a SADI-S patient of the same sex, body mass index (BMI), and weight. Only patients out 5 years and had at least one > 5-year follow-up visit were included. RESULTS The matched cohort included 61 RYGB and 61 SADI-S patients. There was no statistical, demographic difference between the two groups. At 5 years, a 100% follow-up was available in each group. The intraoperative outcomes were significantly better with SADI-S. The 30-day readmission, reoperation, emergency department (ED) visits, and complication rates were statistically similar between the two groups. The long-term complication rates, Clavien-Dindo grade IIIb complications, and number of patients with more than one complication were significantly lower with SADI-S. Weight loss was significantly greater in the SADI-S group at 5 years. The long-term weight-loss failure rate was significantly higher in the RYGB group. The SADI-S procedure was associated with fewer reintervention through 6 years (14.7% patients vs. 39.3% patients, p = 0.001). Conversion or reversal of the procedure was required only in the RYGB group. There also was no significant difference in nutritional outcomes between the two procedures. CONCLUSIONS This study showed that problems, including long-term complications, reinterventions, weight-loss failure, and conversion, were more often associated with RYGB than with SADI-S. The SADI-S may be considered one of the viable alternatives to RYGB.
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Long-term outcomes of primary single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S). Surg Obes Relat Dis 2020; 16:1638-1646. [DOI: 10.1016/j.soard.2020.07.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/26/2020] [Accepted: 07/15/2020] [Indexed: 12/15/2022]
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Surve A, Rao R, Cottam D. Laparoscopic Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy: Surgical Technique. Obes Surg 2020; 30:4684-4686. [DOI: 10.1007/s11695-020-04847-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 11/30/2022]
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A Multi-institutional Study on the Mid-Term Outcomes of Single Anastomosis Duodeno-Ileal Bypass as a Surgical Revision Option After Sleeve Gastrectomy. Obes Surg 2020; 29:3165-3173. [PMID: 31388962 DOI: 10.1007/s11695-019-03917-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Recently, a single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) has become increasingly popular for patients with BMI > 50 as a primary or staged surgery. Staging allows surgeons to do the sleeve gastrectomy (SG) first with the conversion only happening when a failure or technical challenge is identified. PURPOSE We present the mid-term outcomes of SADI bypass surgery after SG. METHOD A retrospective analysis was performed on a prospective database from four institutions. Ninety-six patients were identified from 2013 to 2018. Patients were divided into two groups: one had two-stage SADI because of insufficient weight loss, the second had planned two-stage SADI because of super obesity (BMI > 50 kg/m2). Incidence of complications was divided into < 30 days and > 30 days. RESULT Of 96 patients, 3 patients were completely lost to follow-up. The mean age was 44.8 ± 11.3 years. There were no deaths or conversion to open surgery. The postoperative early complication and late complication rate was 5.3% and 6.4% respectively. At 24 months, group 2 had higher %weight loss (WL) and change in BMI units compared to group 1 with statistically significant difference. The average WL and change in BMI for entire patient's population at 24 months after 2nd stage SADI was 20.5% and 9.4 units respectively. The remission rate for DM was 93.7% with or without the use of medication. CONCLUSION The two-stage approach to SADI-S appears technically simpler than a single compromised operation. However, this approach needs more patients to understand its limitations.
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Abstract
Abstract
Introduction
Single-anastomosis duodenal switch has been suggested to be an effective bariatric procedure that offers excellent weight loss and by lengthening the common channel the potential to reduce micronutrient deficiencies.
Purpose
To evaluate the weight loss, comorbidity resolution and the 1-year nutritional outcomes of the single-anastomosis duodenal switch (SADS) procedure.
Setting
Multiple US Hospitals.
Methods
From October 2014 to January 2017, 120 patients were enrolled at six sites across the USA and underwent the SADS procedure. Weight loss, comorbidities, quality of life, and adverse events were followed post-procedure for 12 months.
Results
At 1, 6, and 12 months, 98.3%, 85.5%, and 77.1% of the patients were available for assessment, respectively. At 12 months, patients showed significantly reduced body mass index when compared to baseline (46.8 ± 5.8 vs 29.8 ± 4.4, P < 0.001 respectively). Sixty-five patients had type 2 diabetes at baseline; however, 11 patients lost to follow-up. Of the available data (54 patients), 96.3% of the patients had a resolution of type 2 diabetes by 12 months with a mean A1C reduction from 7.8 ± 1.6 to 5.3 ± 0.7. Additionally, there were reductions in hyperlipidemia, sleep apnea, and hypertension at 12 months. Patient gastroesophageal reflux disease satisfaction and quality of life (SF-36) scores were significantly higher at 12 months post-procedure (P < 0.001 in all cases) while 12-month protein levels remained at normal values. There were abnormalities of parathyroid hormone and vitamin D at 1 year with all other nutritional markers being not significantly different at 1 year from baseline. There were 10, IIIb, or greater complications according to the Clavien-Dindo scoring system during the study period, not all of which were related to the surgery.
Conclusions
SADS is a highly efficacious weight loss procedure with significant comorbidity reduction at 1 year. At 1 year, complications and vitamin and mineral deficits appear to be consistent with other malabsorption operations. Long-term follow-up is needed, especially around complications and vitamin deficiencies.
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Enochs P, Bull J, Surve A, Cottam D, Bovard S, Bruce J, Tyner M, Pilati D, Cottam S. Comparative analysis of the single-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) to established bariatric procedures: an assessment of 2-year postoperative data illustrating weight loss, type 2 diabetes, and nutritional status in a single US center. Surg Obes Relat Dis 2020; 16:24-33. [DOI: 10.1016/j.soard.2019.10.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 10/08/2019] [Accepted: 10/08/2019] [Indexed: 12/15/2022]
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Zaveri H, Surve A, Cottam D, Cottam A, Medlin W, Richards C, Belnap L, Cottam S, Horsley B. Mid-term 4-Year Outcomes with Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy Surgery at a Single US Center. Obes Surg 2019; 28:3062-3072. [PMID: 29909514 DOI: 10.1007/s11695-018-3358-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) is a modification of Roux-en-Y duodenal switch (RYDS). Long-term data on this operation is lacking in the literature. We reviewed our mid-term data of this RYDS modification. PURPOSE To analyze the outcomes with SADI-S at 4 years. METHODS Data from patients who underwent a primary SADI-S procedure performed by three surgeons at a single institution from June 2013 through February 2018 were retrospectively reviewed. All revision bariatric surgeries were excluded. Regression analyses were performed for all follow-up weight loss data. RESULTS There were 437 patients in our database. The pre-operative mean body mass index (BMI) was 49.8 ± 8.8 kg/m2. The 30-day complication rate was 7.7%. The 30-day readmission, reoperation, and mortality rates were 1.8, 1.3, and 0.2%, respectively. The long-term complication rate was 10.9%. Seventy-nine patients were 4 years post SADI-S surgery and follow-up was possible for 44 patients (55.7%). At 4 years, patients had an average change in BMI of 18.1 ± 6 units with an excess weight loss (EWL) of 85.7 ± 27.3%. At 4 years, 97.6% patients were able to maintain HbA1c < 6% with or without the use of diabetic medication. There was a statistically significant difference between most of the pre-operative and post-operative nutritional data. CONCLUSIONS SADI-S is a safe and effective procedure in both short- and mid-term data points. Diabetes resolution and weight loss appear similar to traditional RYDS and better than RYGB.
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Affiliation(s)
- Hinali Zaveri
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Amit Surve
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Daniel Cottam
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA.
| | - Austin Cottam
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Walter Medlin
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Christina Richards
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - LeGrand Belnap
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Samuel Cottam
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Benjamin Horsley
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
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Horsley B, Cottam D, Cottam A, Cottam S, Zaveri H, Surve A, Medlin W. Bowel Reconstruction to Treat Chronic Diarrhea and Hypoproteinemia Following Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy: a Single-Site Experience. Obes Surg 2019; 29:2387-2391. [DOI: 10.1007/s11695-019-03847-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Surve A, Zaveri H, Cottam D, Cottam A, Cottam S, Belnap L, Medlin W, Richards C. Laparoscopic stomach intestinal pylorus-sparing surgery as a revisional option after failed adjustable gastric banding: a report of 27 cases with 36-month follow-up. Surg Obes Relat Dis 2018; 14:1139-1148. [DOI: 10.1016/j.soard.2018.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 04/23/2018] [Accepted: 05/02/2018] [Indexed: 01/23/2023]
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Neichoy BT, Schniederjan B, Cottam DR, Surve AK, Zaveri HM, Cottam A, Cottam S. Stomach Intestinal Pylorus-Sparing Surgery for Morbid Obesity. JSLS 2018; 22:JSLS.2017.00063. [PMID: 29398898 PMCID: PMC5779797 DOI: 10.4293/jsls.2017.00063] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background and Objective: The Roux-en-Y duodenal switch (RYDS) is one of the most efficient forms of bariatric surgery. However, diarrhea, malnutrition, ulcers, and internal hernias have hampered its widespread adoption. The stomach intestinal pylorus-sparing (SIPS) procedure was developed to alleviate these sequelae while retaining the same weight loss as the RYDS. In this study, we report our midterm experience with this novel technique. Methods: Retrospective analysis was performed on data from 225 patients who underwent a primary SIPS procedure by 2 surgeons at a single center from October 2013 through December 2016. Results: Two hundred twenty-five patients were identified for analysis. The mean preoperative body mass index (BMI) was 52.4 ± 9.1 kg/m2. Forty-eight patients were beyond 2 years after surgery, with data available for 30 patients (62.5% follow-up). Three patients were lost to follow-up. At 2 years, the patients had an average change in BMI of 26.6 U (kg/m2) with an average of 88.7% of excess weight loss. Three deaths were related to the surgery. The most common short-term complication was a leak (2.2%), whereas the most common long-term complication was diarrhea (2.2%). Conclusion: In conclusion, SIPS surgery is a safe procedure with favorable weight loss outcomes at 2 years.
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Affiliation(s)
- Bo T Neichoy
- PanHandle Weight Loss Center, Amarillo, Texas, USA
| | | | | | - Amit K Surve
- Bariatric Medicine Institute, Salt Lake City, Utah, USA
| | | | - Austin Cottam
- Bariatric Medicine Institute, Salt Lake City, Utah, USA
| | - Samuel Cottam
- Bariatric Medicine Institute, Salt Lake City, Utah, USA
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Surve A, Zaveri H, Cottam D, Richards C, Medlin W, Cottam A. Laparoscopic stomach intestinal pylorus sparing surgery in a patient with morbid obesity and situs inversus: first video case report. Surg Obes Relat Dis 2017; 13:122-124. [DOI: 10.1016/j.soard.2016.08.503] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 08/29/2016] [Accepted: 08/30/2016] [Indexed: 10/21/2022]
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Surve A, Zaveri H, Cottam D, Belnap L, Cottam A, Cottam S. A retrospective comparison of biliopancreatic diversion with duodenal switch with single anastomosis duodenal switch (SIPS-stomach intestinal pylorus sparing surgery) at a single institution with two year follow-up. Surg Obes Relat Dis 2016; 13:415-422. [PMID: 28089438 DOI: 10.1016/j.soard.2016.11.020] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 11/22/2016] [Accepted: 11/24/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND The traditional duodenal switch is performed using a Roux-en-Y configuration. This procedure has proven to be the most effective procedure for long-term weight loss and co-morbidity reduction. Recently, stomach intestinal pylorus sparing surgery (SIPS) has been introduced as a simpler and potentially safer variation of the duodenal switch (DS). It is a single anastomosis end-to-side proximal duodeno-ileal bypass with a sleeve gastrectomy. In this study, we compare our outcomes between biliopancreatic diversion with duodenal switch (BPD-DS) and SIPS at 2 years. SETTING This is a retrospective analysis from a single surgeon at a single private institution. METHODS We analyzed data from 182 patients retrospectively, 62 patients underwent BPD-DS while 120 other patients underwent SIPS between September 2011 and March 2015. A subset analysis was performed comparing data from both procedures to evaluate weight loss and complications. RESULTS Of 182 patients, 156 patients were beyond 1 year postoperative mark and 99 patients were beyond 2 year postoperative mark. Five patients were lost to follow-up. None of our patients had complications resulting in death. BPD-DS and SIPS had statistically similar weight loss at 3 months but percent excess weight loss (%EWL) was more with BPD-DS than SIPS at 6, 9, 12, 18, and 24 months. Patient lost a mean body mass index (BMI) of 23.3 (follow-up: 69%) and 20.3 kg/m2 (follow-up: 71%) at 2 years from the BPD-DS and SIPS surgery, respectively. However, patients who had undergone SIPS procedure had significantly shorter operative time, shorter length of stay, fewer perioperative and postoperative complications than BPD-DS (P<.001). Interestingly, even though BPD-DS patients lost slightly more weight, the actual final BMI for SIPS group was lower than BPD-DS group (25.6 versus 26.9) (P<.05). There was no statistical difference between 2 groups for postoperative nutritional data such as vitamins D, B1, B12, serum calcium, fasting blood glucose, glycosylated hemoglobin (HbA1C), insulin, serum albumin, serum total protein, and lipid panel. CONCLUSION The SIPS is a simplified DS procedure. The SIPS eliminates one anastomosis and compared with BPD-DS has fewer perioperative and postoperative complications, shorter operative time and length of stay, and similar nutritional results at 2 years. However, weight loss was more with BPD-DS. A fair criticism is that the vast majority of BPD-DS cases were done before the SIPS cases. As a result, experience and learning curve cannot be completely dismissed when viewing postoperative complications.
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Affiliation(s)
- Amit Surve
- Bariatric Medicine Institute, Salt Lake City, Utah
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A video case report of stomach intestinal pylorus sparing surgery with laparoscopic fundoplication: a surgical procedure to treat gastrointestinal reflux disease in the setting of morbid obesity. Surg Obes Relat Dis 2016; 12:1133-1135. [DOI: 10.1016/j.soard.2016.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 03/30/2016] [Accepted: 04/01/2016] [Indexed: 11/21/2022]
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Surve A, Zaveri H, Cottam D, Belnap L, Medlin W, Cottam A. Mid-term outcomes of gastric bypass weight loss failure to duodenal switch. Surg Obes Relat Dis 2016; 12:1663-1670. [PMID: 27396548 DOI: 10.1016/j.soard.2016.03.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/16/2016] [Accepted: 03/19/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND The Roux-en-Y gastric bypass (RYGB) is a very effective treatment for obesity and its related co-morbidities. However, some patients fail to achieve>50% of their excess weight loss (EWL), and others regain much of the weight that they lost. OBJECTIVE The purpose of this study was to analyze early outcomes after conversion of RYGB to duodenal switch (DS) in terms of weight loss, change in co-morbidities, and complications. SETTING This is a retrospective analysis from 1 surgeon at a single private institution. METHODS We analyzed data from 32 obese patients retrospectively who underwent revision for failed RYGB. Nine patients underwent DS with Roux-en-Y reconstruction (RYDS), and 23 patients underwent single anastomosis DS between October 2012 and December 2015. Regression analyses were performed for all follow-up weight-loss data. RESULTS The patients experienced mean EWL of 16.2% over an average of 16 years (range: 0-38) with their primary RYGB surgery. Of 32 patients who underwent revision DS, 22 patients are beyond the 1-year postoperative mark (follow-up 81.8%), and 15 patients are beyond the 2-year postoperative mark (follow-up 73.3%). One patient was lost to follow-up. The patients experienced mean EWL of 31.2%, 45.1%, 51%, 54.2%, 56%, and 56.4% at 3, 6, 9, 12, 18, and 24 months, respectively, after their revisional surgery. Mean total weight loss achieved at 12 and 24 months was 27.7% and 29.2%, respectively. There was no statistical significant difference in mean %EWL at 12 months (P = .468) and 24 months (P = .266) between RYDS and single anastomosis DS. CONCLUSION A laparoscopic revision from RYGB to DS is an effective weight-loss operation with midterm follow-up of 2 years. Though long-term follow-up is warranted to measure recidivism, the initial data seem favorable.
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Affiliation(s)
- Amit Surve
- Bariatric Medicine Institute, Salt Lake City, Utah
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Gebelli JP, Gordejuela AGRD, Ramos AC, Nora M, Pereira AM, Campos JM, Ramos MG, Bastos ELDS, Marchesini JB. SADI-S WITH RIGHT GASTRIC ARTERY LIGATION: TECHNICAL SYSTEMATIZATION AND EARLY RESULTS. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2016; 29Suppl 1:85-90. [PMID: 27683784 PMCID: PMC5064262 DOI: 10.1590/0102-6720201600s10021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 05/23/2016] [Indexed: 12/31/2022]
Abstract
Background Bariatric surgery is performed all over the world with close to 500.000 procedures per year. The most performed techniques are Roux-en-Y gastric bypass and sleeve gastrectomy. Despite this data, the most effective procedure, biliopancreatic diversion with or without duodenal switch, represents only no more than 1.5% of the procedures. Technical complexity, morbidity, mortality, and severe nutritional adverse effects related to the procedure are the main fears that prevent most universal acceptance. Aim To explain the technical aspects and the benefits of the SADI-S with right gastric artery ligation as an effective simplification from the original duodenal switch. Methods Were included all patients undergoing this procedure from the November 2014 to May 2016, describing and analysing aspects of this technique, the systematization and early complications associated with the procedure. Results A series of 67 patients were operated; 46 were women (68.7%); mean age of the group was 44 years old (33-56); and an average BMI of 53.5 kg/m2 (50-63.5). Surgical time was 115 min (80-180). A total of five patients (7.5%) had any complication and two (2.9%) had to be reoperated. There were two patients with leak, one at the duodenal stump and other at the esophagogastric angle. There was no mortality. Patients stayed at the hospital a median of 2.5 days (1-25). Conclusions SADI-S with right gastric artery ligation is a safe procedure with few preliminary complications. The technical variations introduced to the classical duodenal switch are reproducible and may allow this procedure to be more popular. All the complications in this series were not related to the ligation of the right gastric artery.
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Affiliation(s)
| | | | | | - Mario Nora
- Centro Hospitalar Entre Douro e Vouga, Portugal
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