Paul E Enochs, MD, FACS, FASMBS, David Pilati, MD, AFACS, Jon Bruce, MD, FACS, FASMBS, Scott Bovard, MD, FACS, FASMBS, Michael Tyner, MD, FASMBS. Bariatric Specialists of North Carolina
Background: A modification of the duodenal switch (MDS) utilizing a single anastomosis with 300cm common channel has been gaining popularity since first described by Dr. Torres in 2007. This procedure has gone by many names, including the single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI) and most recently, the Stomach, Intestinal, and Pylorus Sparing procedure (SIPS). However, there are very few studies illustrating definitive results of these procedures.
Methods: Utilizing our internal practice database and electronic medical records, clinical data was obtained for our set of 150 MDS patients who underwent a primary procedure at Centers of Excellence between July 2014 and July 2015. These results were compared with established data found in the literature discussing outcomes of the laparoscopic sleeve gastrectomy (SG), laparoscopic roux- en-y gastric bypass (RYGBP), and laparoscopic traditional duodenal switch (DS) procedures. The main outcomes evaluated at 18 months included excess weight loss; 30 day, 6 month, and 1 year readmission and reoperation rates; resolution of comorbidities; as well as postoperative metabolic and nutritional status.
Results: We analyzed 150 patients who underwent a primary laparoscopic MDS procedure and compared them to similar patients who underwent a laparoscopic sleeve gastrectomy (SG), laparoscopic roux-en-y gastric bypass (RYGBP), or laparoscopic duodenal switch (DS). The EWL in MDS patients at 18 months is similar to DS and greater than SG or RYGBP, while the risk profile, although slightly more than SG, is less than that of RYGBP or DS. The resolution of comorbidities is comparable across procedures as a function of weight loss, yet when focused specifically on diabetes, the MDS appears to show a greater percent resolution than RYGBP and is comparable with DS. At 18 months there have been no appreciable metabolic or nutritional deficiencies as compared to SG or RYGBP and when compared to DS, the metabolic and nutrition profile (specifically fat soluble vitamins A, D, E, and K) is superior at 18 months.
Conclusion: The use of laparoscopic malabsorptive procedures has been increasing on a national level. Compared with our other bariatric procedures, specifically the RYGBP and DS, the Modified Duodenal Switch is associated with a lower risk profile, an equivalent or improved nutritional status, and increased weight loss. Further studies will help to definitively define the role of this promising new procedure and how it plays within our bariatric armamentarium.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79180
Program Number: S020
Presentation Session: Bariatric and Metabolic Surgery
Presentation Type: Podium