The duodenal switch operation for the treatment of morbid obesity - PubMed (original) (raw)
The duodenal switch operation for the treatment of morbid obesity
Gary J Anthone et al. Ann Surg. 2003 Oct.
Abstract
Objective: To determine the safety and efficacy of the duodenal switch procedure as surgical treatment of morbid obesity.
Summary background data: The longitudinal gastrectomy and duodenal switch procedure as performed for morbid obesity involves a 75% subtotal greater curvature gastrectomy and long limb suprapapillary Roux-en-Y duodenoenterostomy. This results in a restricted caloric intake and diversion of bile and pancreatic secretions to induce fat malabsorption. Broad acceptance of this procedure has been impeded because of concerns that the malabsorptive component may produce serious nutritional complications.
Methods: Review of data collected prospectively from all patients who underwent duodenal switch as the primary surgical treatment of morbid obesity at a single institution during the 10-year period beginning September 1992. Operative morbidity and mortality, weight loss, volume of food intake, and bowel function were recorded. Sequential measurements of serum albumin, hemoglobin, and calcium levels were obtained to assess metabolic function and nutrient absorption.
Results: Duodenal switch was performed as the primary operation in 701 (81%) of a total 863 patients undergoing bariatric surgery during the period of study. The average body mass index (BMI) was 52.8 (range, 34-95). Perioperative mortality was 1.4%, and morbidity (including leaks, wound dehiscence, splenectomy, and postoperative hemorrhage) occurred in 21 patients (2.9%). Weight loss averaged 127 pounds at 1 year, 131 at 3 years, and 118 at 5 or more years (% EBWL of 69%, 73%, and 66%, respectively). The mean number of bowel movements was fewer than 3 per day. Patients reported and maintained a mean restriction of 63% of their preoperative intake (approximately 1600 calories), with no specific food intolerance, at 3 or more years follow-up. At 3 years, serum albumin remained at normal levels in 98% of patients, hemoglobin in 52%, and calcium in 71%. No patients reported dumping, and marginal ulcers were not seen.
Conclusions: The longitudinal gastrectomy with duodenal switch is a safe and effective primary procedure for the treatment of morbid obesity. It has the advantage of allowing acceptable alimentation with a minimum of side effects while producing and maintaining significant weight loss. These results are achieved without developing significant dietary restrictions or clinical metabolic or nutritional complications.
Figures
FIGURE 1. The duodenal switch procedure as performed at the University of Southern California for the treatment of morbid obesity. The operation consists of a 75% longitudinal gastrectomy, creation of an alimentary limb approximately 50% of total small bowel length, and a common channel length of 100 cm. A cholecystectomy is routinely performed.
FIGURE 2. The longitudinal gastrectomy is performed by resecting along a line parallel to, and approximately 2 cm from, the lesser curvature. This produces a tubularized stomach of approximately 100 mL.
FIGURE 3. Air insufflation of the retrocolic duodenoenterostomy anastomosis. Note the lack of tension at the suture line.
FIGURE 4. Bar graph showing the yearly accrual rate of patients who had a duodenal switch procedure as their primary weight loss operation during the period of the study. The number of patients per year is shown above the bar.
FIGURE 5. Percent excess body weight loss (%EBWL) for all patients. Graph shows mean and 95% CI for the mean.
FIGURE 6. %EBWL for female patients (solid line) versus male patients (dotted line).
FIGURE 7. %EBWL and preoperative BMI < 50 kg/m2 (solid line) or ≥ 50 kg/m2 (dotted line).
FIGURE 8. Proportion of patients with a successful outcome, defined as %EBWL ≥ 50%. The solid line shows patients with a preoperative BMI < 50 kg/m2 (morbidly obese), the dotted line shows the total patients, and the dashed line shows patients with a preoperative BMI ≥ 50 kg/m2 (supermorbidly obese). P values for the comparison of the super morbidly obese patients with the morbidly obese patients are shown at the bottom of the graph at the specific follow-up intervals (Fisher exact test).
References
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