A retrospective comparison of SDS with LDS at a single institution

Samuel H Cottam1, Daniel R Cottam, MD1, Legrand Belnap, MD1, Mitch Roslin, MD2. 1BMI, 2Lenox Hill Hospital and North Shore LIJ

Background: The duodenal switch is currently the best operation in terms of weight loss. However, it has suffered from the perception that it is too difficult to perform and has undesirable side effects of multiple daily bowel movement, malnutrition and foul smelling flatulence.

Methods: A historical comparison study was conducted. All patients who presented for a duodenal switch between September 2011 and May 2013 received a standard duodenal switch (SDS) and those who presented between June 2013 and March 2014 received a Loop duodenal switch (LDS). All patients were evaluated on a intent to treat basis. Data was collected prospectively and analyzed retrospectively. All patients were subject to the same preoperative education regarding calorie reduction and lifestyle changes, and received the same postoperative counseling regarding exercise, food choices, and eating behavior.

Results: During these periods 66 patients received a SDS with a 150cm common channel and a 150 cm Roux limb and 69 patients received a LDS with a 300cm common channel. The two groups are similar in terms of age, sex, BMI. The SDS had statistically significantly higher co-morbidities than the LDS. There were no deaths in either group. Weight loss showed no significant difference between the groups. There was less incidence of malnutrition, fewer bowel movements and fewer complaints of foul smelling gas in the LDS versus the SDS. The LDS took significantly less time to perform than the SDS.

Conclusion: The LDS is similar in terms of weight loss to the SDS with fewer side effects and malnutrition complications. It also is much easier to perform as evidence by the time it took to perform the procedure.

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