More evidence supporting the superiority of the DS

A new paper by Marceau et al. detailing 15 years of DS results:

Obesity Surgery, 17, 1421-1430 (2007)

Duodenal Switch: long-Term Results

Picard Marceau, MD, PhD1;Simon Biron, MD, MSc1; Frederic-Simon Hould, MD1; Stefane. Lebel, MD1; Simon Marceau, MD1; Odette Lescelleur, MD1; Laurent Biertho, MD1; Serge Simard, MSc2

'Department ofSurgery, Laval University, Laval Hospital, Quebec, Canada; 2Biostatistician Laval Hospital Research Center

Results: Survival rate was 92% after DS. The risk of death (Excess Hazard Ratio (EHR) was 1.2, almost that of the general population. After a mean of 7.3 years (range 2-15), 92% of patients with an initial BMI > 50 kg/m2 obtained a BMI <35 and 83% of those with an initial BMI >50 obtained a BMI <40.  Diabetes was cured (i.e. medication was discontinued) in 92% and medication decreased in the others. The use of the CPAP apparatus was discontinued in 90%, medication for asthma was decreased in 88%, and the prevalence of a cardiac risk index >5 was decreased by 86%.  Patients' satisfaction in regard to weight loss was graded 3.6 on a basis of 5, and 95% of patients were satisfied with the overall results. Operative mortality was 1% which is comparable with gastric bypass surgery. The need for  revision for malnutrition was rare (0.7%) and total reversal was exceptional (0.2%).  Failure to lose >25% of initial excess weight was 1.3%.  Revision for failure to lose sufficient weight was needed in only 1.5%.  Severe anemia, deficiency in vitamins or bone damage were exceptional, easily treatable, preventable and no permanent damage was documented.

Conclusion: In the long term, DS was very efficient in terms of cure rate for morbid obesity and its comorbidities.  In terms of risk/benefit, DS was very sucessful with an appropriate system of follow-up.

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Discussion

In our view, morbid obesity is a metabolic disease that extends beyond uncontrolled appetite and abnormal food intake.  For the past 25 years, our goal has been to change the basic physiology of these patients, allowing for excess weight loss, maintenance of weight loss and continuation of a normal life. We consider that it is important for quality of life to be able to eat normally. We felt that it was preferable not to concentrate our effort on food restriction, giving a false impression that the only problem is a lack of control of food intake, but rather to target correction of the metabolic dysfunction.  In these patients, the difficulty has never been to attain weight loss, but to maintain that weight loss. Morbid obesity should be considered a chronic disease, which requires treatment for life.

The first 8 years (1982-1990), BPD as described by Scopinaro was the procedure of choice within this center. While the results were positive, a decrease in side effects with improvement of absorption were further targets. The procedure was modified successfully. For the last 15 years (1992-2007), DS has been our primary procedure for all patients. This choice has been reinforced with additional knowledge on important involvement of intestinal hormones in the etiology of obesity.  It was also reinforced by the high long-term failure rates reported for numerous other procedures.

The present study could be considered exceptional.  The Canadian medical system has facilitated an efficient follow-up of a large unselected cohort.  We are not aware of any comparable study, using a consistent procedure with such an extended and thorough complete follow-up.

Our review shows excellent long-term results after 15 years. Both the weight loss and its maintenance compared favorably with any other procedure.  It has the best "cure rate" where cure rate is defined as the absence of morbid obesity: 83% of those with an initial BMI >50 maintained a BMI <40 and 92% of those with an initial BMI <50  maintained a postoperative BMI <35.

DS also targeted co-morbidities. It "cured" most diabetic and dyslipidemic patients. For other associated morbidities, results were related to the extent of weight loss, where DS was as efficient as any other procedure.

The reluctance for using DS has been the concern over long-term risks. The present review should be reassuring. The procedure saves lives. A 15-year survival rate of 92% is much better than that of nonoperated morbidly obese subjects and perhaps even better than after RYGBP.8  The operative mortality was found to be comparable to that of RYGBP.13

The long-term risk for malnutrition is real but preventable. Deficiency in albumin, iron, calcium and fat-soluble vitamins requires compliance and medical attention. These deficiencies were rare, they appeared slowly, and were always  reversible without permanent damage.

The procedure was relatively secure for bone maintenance.  It is possible that with the medical attention provided after surgery, including increased physical activity, better alimentation and appropriate nutritional supplements, the procedure may even be beneficial for bone metabolism, rather than representing a risk.

The negative side-effects with DS were not benign.  The unpleasant odor of stool and gas and the frequent abdominal bloating were the price to pay for these patients and it was a major preoccupation for many of them. However, 95% of patients declared themselves satisfied despite this handicap and no one has required reversal of the procedure for this reason.

The present evaluation has an important characteristic, in that it is comprised of a non-selected group of patients. No pre-selection was done on the basis of age, BMI, eating behavior, financial or psychological conditions, merits or expected difficulties for follow-up. With appropriate support, the procedure was found to be useful for all groups.

Thus, the global applications should be appreciated. We conclude that with a structured and devoted treatment team, DS is a very efficient bariatric operation, to the great satisfaction of both the patients and the care-providers.

Finally, one of the striking conclusions of this study is that, in spite of the inherent mortality risk of the bariatric surgery, the long-term outcomes are more positive than the mortality risk without surgery.  Furthermore, in spite of the side-effects which are not minimal, the overall patient satisfaction dominates.  These two points highlight the profound effect that morbid obesity has, not only on mortality, but also on quality of life.

Hmmm.  I had gastric bypass...started with a BMI of 55 and and now have a BMI of technically less than 30....wonder where that puts me on the charts. It's what you do with the tool you're given imo

Are you 15 years out?

So do DS'rs have stock it to sell it?  Im sold... oh wait... when I had my surgery, my insurance wouldnt cover DS, and I seem to have the same results as the successful DS'r... I wear a 6 to 8, I eat normally, I am healthy... and life is good.  If I had it to do over now... perhaps I would have had a DS... but... since I didnt.. GO OPEN RNY...

Yes, we all get surgeon finder fees!  NOT!!!!  You guys are ridiculous when you say things like this.  Ever heard of caring for your fellow man/woman and paying it forward so they can also have the opportunity to see if what works for you may work for them?  We want to provide people in the research phase with information (as knowledge is power), especially when making a choice for a surgery you have to live with for the rest of your life.  D@mn, I really *do* wish I could be paid for informing others about the DS!!!  Maybe it would be worth all the flaming and whining we have to listen to just to get the word out. 

You guys just seem a little cultish sometimes about getting the word out... Superior is a word I wouldnt use when discribing any one surgery over another... personal decisions between a person and their doctor is how folks should be making these choices... All surgerys can be good for sertain folks... no surgery is offering the winning lottery numbers and trying to sell people on one over another seems a bit zelot to me...  SORRY That my smarmy question and coments came of as FLAMING and WHINING to you.. it wasnt... but perhaps this is... a bit more in that tone.

I didn't use the word superior, though it was the superior choice for ME.  The problem with people making a decision based on what their doctor says, is that not all bariatric surgeons are qualified to perform the DS.  They'd be literally crazy to tell a patient, "Why no, I don' t do the DS but it's really showing some fabulous long term numbers, maybe you should find a surgeon that if qualified to do that surgery!"  It just wouldn't make good business sense.  It'd be like a Chevy salesman telling someone that they might wanna go check out the BMW dealer for a nicer car.  It just isn't going to happen.  YKWIM?  The DSers that are over here singing praises about our surgery are doing it to possibly help a fellow obese person find the right surgery for them.  I didn't actually mean that you were being flaming or whining, just making a general comment about people jumping all over DSers when we come over here to the main board where we're supposed to be able to visit. 

OK I feel better, lets not get into the crazy stuff... Sorry I jumped in your crap... I am even more sorry I said something that allowed a green stone the oppertunity  join with me to some degree and be mean to you... I think I need a shower... Honestly if I had to do it all over again... I may have looked further... but I found a sergeon that I felt completely comfortable with, and my insurance at the time gave me one option and I WAS RUNNING WITH IT.  Besides... that gas thing... it aint just for the DS'rs so my husband would say to ya. Judging by your ticker... you and I have mu*****ommon... except you got to the 145 that I am still pineing away at getting to... and so there you have it.  Your always welcomed to the board... all of you...

lma0

Diana help me out here. Its been a long day and its been one bad thing after another so I might not be seeing it. Were does it say superior? I don't see the comparitive #s. What are the statistics its been compared against?