Second-stage duodenal switch for sleeve gastrectomy failure: A matched controlled trial

Area of Science:

• Bariatric Surgery
• Metabolic Surgery
• Gastroenterology

Background:

• Sleeve gastrectomy (SG) is a prevalent bariatric procedure globally.
• Management strategies for suboptimal outcomes post-SG remain a subject of debate.

Purpose of the Study:

• To assess the efficacy and safety of converting SG to biliopancreatic diversion with duodenal switch (BPD-DS) for patients with inadequate weight loss.
• To compare outcomes of staged BPD-DS (following SG) with single-stage BPD-DS.

Main Methods:

• A retrospective analysis of patients undergoing laparoscopic second-stage DS after SG for weight loss failure.
• Patients were matched 1:1 with a cohort undergoing primary single-stage laparoscopic BPD-DS.
• Follow-up data, including weight loss and comorbidity remission, were collected and analyzed.

Main Results:

• No significant differences in baseline characteristics were observed between the staged and single-stage BPD-DS groups.
• Both groups demonstrated significant excess weight loss (EWL) and total weight loss (TWL) post-surgery.
• Second-stage DS achieved 74.8% EWL at 1 year, compared to 87.9% for single-stage BPD-DS (P=.00021).
• Type 2 diabetes remission rates were high in both groups (94%), and hypertension remission was 77% after second-stage DS.

Conclusions:

• Second-stage DS is a viable and effective option for managing suboptimal results after SG, leading to substantial weight loss and metabolic improvement.
• The staged approach yields comparable results to single-stage BPD-DS at three years.
• Further long-term follow-up is necessary to fully evaluate the durability of outcomes.