American Surgical Association

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Topic: C. Clinical GI
Duodenal Switch Operative Mortality and Morbidity are Not Impacted by BMI
Henry Buchwald, Todd A Kellogg, Daniel B Leslie, Sayeed Ikramuddin
University of Minnesota, Minneapolis, MN

OBJECTIVE(S): Duodenal switch (DS) is the most weight effective and the most difficult to perform bariatric procedure. Indeed, certain surgeons have advocated a 2-stage approach to minimize complications, especially in the super obese (BMI ≥50). This report examines the ≤30 day postoperative mortality and morbidity in our first 181 DS.
METHODS: DS procedures were performed (n=181) by either open (n=164) or laparoscopic surgery in an academic setting: common channel 75-100 cm, sleeve gastrectomy (~100 ml gastric pouch), closed duodenal stump; end-to-side duodenoileostomy hand-sewn in 2 layers, and all mesenteric defects closed.
RESULTS: 142 patients (78%) female, mean age 44 years (16-70). Mean preoperative BMI 53.4 kg/m2 (32-107) and weight 151.4 kg (95.5-332.7). 94 patients (51.9%) were super obese (BMI≥50 kg/m2). Mean hospitalization time 6.5 days (2-38). 74 patients had concurrent procedures e.g., cholecystectomy (n=22), ventral or umbilical hernia repair (n=19), hiatus hernia repair (n=10). ≤30-day mortality was 0%. There was one leak (0.6%) ≤30-day occurring at the esophagogastric junction and responding to drainage. Other significant ≤30-day complications (n=18 in 17 patients) were not life-threatening, i.e., acute pancreatitis (n=1); gastric outlet obstruction (n=1), mild acute renal failure (n=2), pneumonia (n=1), respiratory failure (n=2), duodeno-ileostomy stricture requiring dilation (n=1), bleed (n=3), and wound infections (n=8). Complication rate in patients with a BMI <50 was 8.0% (7 of 87) and 11.7% (11 of 94) with a BMI ≥ 50 (NS).
CONCLUSIONS: DS can be performed relatively safely in the morbidly and super morbidly obese, and does not require a 2-stage procedure.


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