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Single and dual anastomosis duodenal switch for obesity treatment: a single-center experience

  • Ana Marta Pereira
    Correspondence
    Correspondence: Ana Marta Pereira, M.D., Centro Hospitalar Entre Douro e Vouga, General Surgery Department, 8th floor, R. Dr. Cândido Pinho 5, 4520-211 Santa Maria da Feira, Portugal.
    Affiliations
    Department of General Surgery, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
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  • Marta Guimarães
    Affiliations
    Department of General Surgery, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal

    Endocrine, Cardiovascular & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine, University of Porto, Porto, Portugal

    Department of Anatomy, Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
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  • Sofia S. Pereira
    Affiliations
    Endocrine, Cardiovascular & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine, University of Porto, Porto, Portugal

    Department of Anatomy, Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
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  • Rui Ferreira de Almeida
    Affiliations
    Department of General Surgery, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
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  • Mariana P. Monteiro
    Affiliations
    Endocrine, Cardiovascular & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine, University of Porto, Porto, Portugal

    Department of Anatomy, Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
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  • Mário Nora
    Affiliations
    Department of General Surgery, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
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Published:September 23, 2020DOI:https://doi.org/10.1016/j.soard.2020.09.029

      Highlights

      • SADI-S and BPD/DS showed similar efficacy and safety
      • BPD/DS showed greater total weight loss
      • SADI-S is technically simpler and less time consuming
      • SADI-S can represent an advantage over BPD/DS

      Abstract

      Background

      Biliopancreatic diversion with duodenal switch (BPD/DS) is the most effective bariatric surgery in super-obese patients, although technically complex and time consuming. As a primary surgery, single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is similar to BPD/DS in terms of short-term outcomes, but long-term and comparative data are lacking.

      Objectives

      The aim of this study was to compare the outcomes of patients submitted to SADI-S and BPD/DS.

      Setting

      Public hospital.

      Methods

      Obese patients (n = 112) submitted to SADI-S (n = 83) and BPD/DS (n = 29) for obesity treatment were prospectively compared.

      Results

      The mean preoperative body mass indexes (BMIs) were 53.41 ± .93 for BPD/DS and 50.61 ± .52 kg/m2 for SADI-S. Follow-up of 48 months was achieved in 18% (n = 21) of patients, with a nonsignificant difference in the percentage of excess BMI loss (%EBMIL; 81.20 ± 3.71 for BPD/DS; 74.82 ± 3.45 for SADI-S). Operative time (164.30 ± 7.78 minutes for BPD/DS; 132.70 ± 7.19 minutes for SADI-S; P = .006) and hospital stay (4.90 ± 1.10 days for BPD/DS; 4.35 ± .70 days for SADI-S; P = .006) were significantly shorter for SADI-S. There was no significant difference in the 30-day postoperative complication rate. No mortality was reported. After surgery, significant improvements were observed in glucose and lipid profiles for both groups. The type 2 diabetes remission rate was 100% for BPD/DS and ranged from 60 to 80% for SADI-S across follow-up times. Dyslipidemia remission followed a similar pattern. Protein deficiency was observed in up to 50% of patients after BPD/DS and 20% after SADI-S, without statistically significances.

      Conclusion

      SADI-S and BPD/DS as primary surgery for obesity treatment result in no significant differences in %EBMIL, improvement in obesity-related diseases, nutritional deficiencies, and postoperative morbidity. Nevertheless, there was greater total weight loss after BPD/DS. SADI-S, being less time consuming and technically simpler, can represent an advantage over BPD/DS.

      Key words

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      Linked Article

      • Comment on: Single and dual anastomosis duodenal switch for obesity treatment: a single center experience
        Surgery for Obesity and Related DiseasesVol. 17Issue 1
        • Preview
          The quest for the ideal or perfect bariatric procedure continues. Perhaps it is an unachievable goal. Whereas the objective of the vast majority of surgical procedures is to remove disease or reconstruct a damaged area, bariatric and metabolic surgery does the opposite. It alters normal tissue to create a controlled abnormality. The stomach is reduced in size and the amount of the intestine in contact with food is shortened. While the objective is to reduce hunger and promote early satiety, these alterations have repercussions.
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      • Comment on: Single and dual anastomosis duodenal switch for obesity treatment: a single center experience
        Surgery for Obesity and Related DiseasesVol. 17Issue 1
        • Preview
          I read with interest the article entitled “Single and Dual Anastomosis Duodenal Switch for Obesity Treatment: A Single Centre Experience,” in which single-anastomosis duodeno-ileostomy (SADI-S) was compared with duodenal switch (DS) in a single, public hospital in a nonrandomized fashion [1]. Although the patients who underwent DS had a slighter higher mean preoperative body mass index (BMI) of 53.4 kg/m2, versus 50.6 kg/m2 in the patients who underwent SADI-S, this difference was not significant.
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