Superobese and super-superobese patients: 2-step laparoscopic duodenal switch

• Published in: Surgery for obesity and related diseases Vol. 7; no. 6; pp. 703 - 708
• Main Authors: Dapri, Giovanni, M.D., F.A.C.S., F.A.S.M.B.S, Cadière, Guy Bernard, M.D., Ph.D, Himpens, Jacques, M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2011
• Subjects: 2-step; Adult; Anastomosis, Surgical; Bariatric Surgery - methods; Biliopancreatic Diversion - methods; Duodenal switch; Duodenum - surgery; Female; First step; Gastrectomy - methods; Gastroenterology and Hepatology; Humans; Laparoscopy - methods; Length of Stay; Male; Middle Aged; Obesity, Morbid - surgery; Prospective Studies; Retrospective Studies; Sleeve gastrectomy; Super-superobese patients; Superobese patients; Surgery; Treatment Outcome; Weight Loss; Young Adult; First step; Duodenal switch; 2-step; Superobese patients; Super-superobese patients; Sleeve gastrectomy
• ISSN: 1550-7289; 1878-7533
• DOI: 10.1016/j.soard.2011.09.007

Abstract Background Morbidity and mortality after bariatric surgery in superobese (body mass index [BMI] >50 but <60 kg/m2 ) and super-superobese (BMI >60 kg/m2 ) patients can allegedly be reduced by performing surgery in 2 steps. We report a retrospective study gathered from a prospective database for superobese and super-superobese patients who underwent laparoscopic biliopancreatic diversion/duodenal switch (LBPD/DS) after laparoscopic sleeve gastrectomy (LSG) as the first step. Methods From October 2004 to June 2010, 31 patients underwent LBPD/DS after LSG. The mean age was 45.8 ± 10.1 years (range 21–64). The mean interval between the 2 procedures was 13.9 ± 8.4 months (range 6–37). At LSG, the mean weight and BMI was 168.8 ± 35.4 kg (range 127–255) and 58.3 ± 6.7 kg/m2 (range 50–74.5). At LBPD/DS, the mean weight, BMI, and percentage of excess weight loss was 136.3 ± 32.6 kg (range 92–220), 47.1 ± 7.2 kg/m2 (range 37.8–64.3), and 31.6% ± 12.2% (range −11.7 to +54.6). At LSG, 26 patients had 43 obesity co-morbidities. Three co-morbidities (6.9%) resolved in 3 patients before the second step of LBPD/DS was performed. Results The mean operative time was 175.5 ± 60.6 minutes (range 75–285). There were no deaths or conversions to open surgery. Four patients had early complications (1 anastomotic leak, 1 small bowel perforation, 1 case of renal insufficiency, and 1 case of pneumonia). The mean hospital stay was 6.6 ± 8 days (range 3–35). All patients, with the exception of 3, were followed up for a mean of 28.8 ± 21.4 months (range 4–71). At follow-up, the mean weight, BMI, and percentage of excess weight loss (compared with the pre-LSG weight) was 99.4 ± 23.7 kg (range 62–150), 34.5 ± 5.8 kg/m2 (range 24.9–46.3), and 54.8% ± 16% (range 18.9–84.8). A total of 22 obesity co-morbidities (51.1%) resolved in 14 patients. Three patients presented with late complications (1 ventral hernia, 1 case of protein deficiency, 1 anastomotic stenosis). Conclusion In the treatment of superobese and super-superobese patients with 2-step LBPD/DS, we experienced no deaths and achieved acceptable morbidity, considering the high operative risk in this group. This procedure is effective for both weight loss and resolution of co-morbidities.