Can Single Anastomosis Post Pyloric Bypass or Loop Duodenal Switch be the bariatric operation of the future?

Andrew R Brownlee, MD, Yuriy Dudiy, MD, Mitchell Roslin, MD, FACS. Lenox Hill Hospital.

 Introduction: For years the mechanisms of action for bariatric procedures were considered to be restriction and malabsorption. Recently, it has been found that hormonal changes such as reduction of ghrelin, or increased PYY and incretins are involved in hunger suppression and satiety. As a result, a procedure that could achieve ghrelin suppression, stimulate L cells by having food enter the distal intestine, preserve the pyloric valve to control emptying and reduce the technical difficulty of the classic Duodenal Switch could be an attractive alternative.

Methods: Between February 2013 and present we have performed 8 single anastomosis or Loop duodenal switches. The technique involves creation of a sleeve gastrectomy over a 42F bougie, division of the duodenum with 3 cm cuff, and attachment end-to-side (hand sewn) to the small bowel 3 meters proximal the ileo-cecal valve. Synchronous cholecystectomy was performed.

Results: The mean BMI was 56.4(48-74). Four of the patients were female and 4 were males. The mean OR time was 111 minutes. There were no significant complications or leaks. Early weight loss results appear identical to the classic DS. No patient has required treatment for frequent bowel movements or hospital re-admission.

Conclusions: Single Anastomosis Post Pyloric Bypass or Loop Duodenal Switch is a rational concept that begs further exploration. At this stage, no conclusion regarding outcomes can be delivered. Eliminating an anastomosis and potentially lengthening the common channel, while still performing a sleeve gastrectomy, preserving the pyloric valve and titrating total intestinal length are attractive features. In comparison to mini gastric bypass, bile travels several meters in an afferent limb and meets the duodenum past the pylorus. Thus the risk of bile reflux gastritis or increased oncologic risk to the stomach is remote. Long-term studies that investigate complications, the risk of micronutrient deficiencies and impact on co-morbid conditions are necessary.

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