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Long-term Safety of the Duodenal Switch for Morbid Obesity: Results in 1156 Patients
Namir Katkhouda*, Joerg Zehetner*, Naila Khalaf*, Evgeniya Degnera*, Peter F Crookes*, Thomas V Berne, Rodney J Mason*
Keck School of Medicine of USC, University of Southern California, Los Angeles, CA

Objective:
The duodenal switch for treatment of morbid obesity combines restriction and malabsorption and yields the greatest weight-loss among bariatric procedures but its long-term safety is unclear. Our objective was to assess long-term complications and analyze factors associated with morbidity and mortality.
Methods:
Of 1315 patients who underwent a duodenal switch for morbid obesity in a tertiary university hospital between 1993 and 2010, long-term data was available on 1156 patients. Follow-up included readmission data, telephone interviews and social-security queries for mortality and focused on safety as weight-loss data was previously published.
Results:
Median age (M/F=227/929) was 42 years (16-86) with a median BMI of 51 kg/m2 (37-79). Overall complication rate was 53% and perioperative mortality (<30days) was 0.5%. Procedure-related mortality (>30days) was 1.2% and overall mortality was 7.3% [median follow-up 111 months(7-220)]. Readmission and reoperation rates were 53% (median 2 readmissions) and 38% respectively. Morbidity was significantly higher in non-white patients (63%vs.52%, p=0.008) and BMI>60kg/m2 (60%vs.52%, p=0.047). Most common complications were severe malabsorption(11%), strictures(10%), leaks(4.6%) and incisional hernias(27%). Incidence of GERD showed a linear increase over time. Overall mortality was significantly higher in males (10.6%vs.6.5%, p=0.032) and patients with BMI>60kg/m2 (10.7%vs.6.5%, p=0.037). On multivariate analysis, age>40 years (OR 1.4, p=0.02), non-white (OR 1.61, p=0.006), and patients with more than 2 co-morbidities (OR 1.4, p=0.009) were significant factors for complications, with similar results for mortality.
Conclusions:
The duodenal switch is associated with high ongoing morbidity and mortality. The duodenal switch should not be recommended as a primary procedure for morbid obesity.


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