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Single Versus Double-Anastomosis Duodenal Switch: Single-Site Comparative Cohort Study in 440 Consecutive Patients
Pablo Finno1, Javier Osorio2, Amador García-Ruiz-de-Gordejuela1
1Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, FeixaLlarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
Obesity Surgery
|April 3, 2020
Summary
Duodenal switch (DS) and single-anastomosis DS with sleeve gastrectomy (SADI-S) offer similar weight loss and comorbidity remission. DS provides better BMI control in severe obesity but has more long-term complications and nutrient deficiencies.
Area of Science:
- Bariatric surgery
- Metabolic and endocrine surgery
- Surgical outcomes research
Background:
- Morbid obesity is a complex metabolic disease requiring effective surgical interventions.
- Duodenal switch (DS) and single-anastomosis DS with sleeve gastrectomy (SADI-S) are established bariatric procedures.
- Comparative data on long-term outcomes, complications, and nutritional status between DS and SADI-S are crucial.
Purpose of the Study:
- To compare weight loss, comorbidity remission, complication rates, and nutritional deficits between DS and SADI-S.
- To evaluate the efficacy of these procedures in patients with varying degrees of obesity.
- To identify potential long-term risks and benefits associated with each surgical technique.
Main Methods:
- Retrospective review of 440 patients undergoing DS (n=259) or SADI-S (n=181) for morbid obesity.
- Analysis of preoperative BMI, follow-up duration, weight loss, comorbidity remission, complications, and nutritional deficiencies.
- Statistical comparison of outcomes between the two surgical groups.
Main Results:
- Both DS and SADI-S demonstrated similar excess weight loss (77.4% at 2 years).
- Comorbidity remission rates (diabetes, hypertension, dyslipidemia, sleep apnea) were comparable between groups (e.g., 85.2% for diabetes).
- DS showed superior BMI control (<35 kg/m²) and diabetes remission in patients with initial BMI >55 kg/m² (80% vs. 50%, p=0.025).
- DS was associated with higher rates of long-term complications and vitamin/micronutrient deficiencies compared to SADI-S.
Conclusions:
- DS and SADI-S achieve comparable weight loss and comorbidity resolution at 2 years.
- For patients with BMI >55 kg/m², DS offers better BMI reduction and diabetes remission but necessitates vigilant monitoring for complications and nutritional deficits.
- SADI-S may represent a potentially safer alternative with fewer long-term complications and supplementation needs.
