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Amanda-DS's Blog
Amanda-DS's Blog


More studies of the superiority of the DS
on June 24, 2009 6:36 am

DDW: Duodenal Switch Outperforms Gastric Bypass

By Todd Neale, Staff Writer, MedPage Today
Published: June 04, 2009
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
Earn CME/CE credit
for reading medical news

 
CHICAGO, June 4 -- For the "super-obese," duodenal switch surgery appears to be superior to gastric bypass for resolving obesity-related comorbidities, a researcher said here. Action Points  
  • Explain to interested patients that this was not a randomized trial and that resolution of comorbidities was assessed according to discontinuation of medications.

     
  • Note that this study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

Three years after surgery, patients with a body mass index of 50 kg/m2 or higher who underwent the duodenal switch procedure were less likely to need medications for diabetes, hypertension, and dyslipidemia, than those who underwent Roux-en-Y gastric bypass, Vivek Prachand, M.D., of the University of Chicago, reported at Digestive Disease Week.

 

The bypass patients were more likely to see a resolution of gastroesophageal reflux disease, Dr. Prachand said.

 

He and his colleagues had previously shown that duodenal switch resulted in greater weight loss than gastric bypass in the heaviest patients, who are, on average, about 200 pounds over their ideal weight. (See Duodenal Switch Called Bariatric Surgery of Choice for 'Super-Obese')

 

However, he said, the greater resolution of comorbidities with this procedure occurred independently of the amount of weight lost.

 

The researchers followed the 350 patients from the weight-loss study for three years to assess the degree of comorbidity resolution in those who underwent duodenal switch (198 patients) and those who had gastric bypass (152 patients).

 

The prevalence of comorbidities before surgery was similar in both groups, except for a lower rate but greater severity of diabetes in the group undergoing duodenal switch.

 

Three years after surgery, duodenal switch resulted in greater total weight loss (173.5 versus 118 pounds, P<0.01), a greater percentage of excess weight loss (68.9% versus 54.9%, P<0.01), and lower BMI (33.6 versus 37.2 kg/m2, P≤0.05).
 

Those who underwent duodenal switch surgery were more likely to be able to stop using medications for diabetes (100% versus 60%), hypertension (68% versus 39%), and dyslipidemia (72% versus 26.3%), but less likely to discontinue medications for gastroesophageal reflux disease (48.6% versus 76.9%) (P<0.05 for all).

 

Dr. Prachand said gastric bypass is better at reducing acid reflux because there is little acid production occurring in the remaining small stomach pouch. The procedure also reduces the ability for bile to come back up into the esophagus.

 

Although duodenal switch surgery resulted in greater weight loss, that did not appear to explain the difference in the resolution of comorbidities, he said.

 

The mechanisms remain unclear, but research is currently exploring the contribution of gut hormones and other factors.

 

For example, the hormone GLP1, which affects insulin secretion and glucose sensitivity, might respond differently following the two operations, Dr. Prachand said.

 

Although duodenal switch surgery appears to have multiple benefits over gastric bypass for the super-obese, surgeons have been reluctant to adopt the procedure, which accounts for fewer than 10% of all weight-loss operations.

 

One major downside of the procedure is that the resulting malabsorption of calories also applies to vitamins and other nutrients. Because many of the super-obese have vitamin deficiencies even before surgery, there is the potential for malnutrition, Dr. Prachand said.

 

In addition, he said, duodenal switch surgery is more technically difficult and results in higher morbidity and mortality and alterations in bowel habits.

 

Dr. Prachand acknowledged that the study was limited by selection bias because the participants were not randomized and by the nonphysiologic measurement of comorbidity resolution.

 

Dr. Prachand reported no conflicts of interest.


Primary source: Digestive Disease Week
Source reference:
Prachand V, et al "Duodenal switch provides superior resolution of metabolic comorbidities independent of weight loss in the super-obese (BMI ≥50 kg/m2" DDW 2009; Abstract 459.

 
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Canadians love the DS too
on June 20, 2009 5:32 am
1: Obes Surg. 2007 Nov;17(11):1421-30. Links
 

Duodenal switch: long-term results.

Marceau P, Biron S, Hould FS, Lebel S, Marceau S, Lescelleur O, Biertho L, Simard S.

Department of Surgery, Laval University, Laval Hospital, Québec, Canada. picard.marceau@chg.ulaval.ca

BACKGROUND: This report summarizes our 15-year experience with duodenal switch (DS) as a primary procedure on 1,423 patients from 1992 to 2005. METHODS: Within the last 2 years, follow-up of these patients, including clinical biochemistry evaluation by us or by their local physician is 97%. 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 < or = 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.

PMID: 18219767 [PubMed - indexed for MEDLINE]

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complments or veiled insults to the old you
on June 3, 2009 5:14 am
Someone posted today about the discomfort with compliments and it stopped me to think a bit. Here is my answer.
take them all and hoard them in your mind and soul............

because after awhile the new post-DS you will be just that you, people will get used to it!!!!

Then when the compliments stop coming as frequently you can pull those babies out when faced with the drudgery of maintainence..... All the work and none of the immediate perks....no scale giving you a new number,  no people stroking you with compliments. Those remembered compliments will be positive reinforcement for your new lease on life.

Now if you are a doom and gloom person, if you need negative reinforcement to keep you on the straight and narrow----------you fill your mind with images of the pre-op you, you take the flip side of the compliments ---they say I look so good now, how bad did I look before......they want to be my friend now where were they before...... Listen fear of regain is a powerful motivator for many on this site.

So do you want to bask in the light of your accomplishment, and let these compliments shine on you too....... or do you keep looking back to the shadows to see your old self, and those compliments ( or veiled insults to the old you) will litter the way back

doing a bit more!
on April 25, 2009 7:36 am
You never know who you have touched by doing the little things.

A lovely lesson for me this week-I had an client at work that called one day to ask if it was possible to bring his wife who had Alzheimers with him to the Rehab swim class. Her aide had been called up to jury selection. So I left my office looked over the facility (under going renovations) and realized I had one dressing room outside the womens and mens room. We usually keep the scale in there. So I haul out the scale, print a sign on the computer saying saved for them. Call him back. He was so touched to be able to bring her again, introduced her personally to all our new members who did not remember her. I spent some extra time with her at the end of class. She and I walked the shallow end singing some WW2 songs together, while he exercised harder in the deep end. I helped her through the shower and brought her out to him so he could help her get dressed. For that entire week they came to class together until the aide was back. All together maybe 30 extra minutes out of my  work day was spent on doing this.

He unexpectedly died of a heart attack last Monday. At the funeral one of his 5 daughters spoke of the kindness I and the YWCA had shown to her dad. How thrilled he was to take his wife out among his friends and he had called all five daughters to talk about it.

So you never know when you do a kindness how much joy and caring you give someone else.

On the days since when little and big annoyances get me down at work. I just think about the fact that I truly made a difference for a wonderful man and his wife.

working 9-5, I wish!
from being a full time mom and barely able to do that before surgery. I am working 3 jobs at 7 years out.

All three are my dream jobs
1) teaching religious school-5th grade prayer, and the Sunday 8th, 9th & 10th graders.
2) working for my husband and another doctor  20 hours a week, helping with EMR(electronic medical records) get to use my medical knowledge without having to be on my feet, work the crazy pediatric office hours, no malpractice worries. Most importantly my working for my husband frees up his time so he can be more productive, and with the second child starting college next year we certainly can use the extra money.
3)Pool supervisor and Recreation and Fitness Director for the YWCA- supposed to be a 30hour a week job. Due to a lack of lifeguards and special programning I have been putting in a 30-36 hour week.

There are some days I leave at 6:30 in the morning to do my own exercise. Start work at 7:30 and work at two different jobs during the day. This may get old but right now after the first month at this pace I am loving it. The bad part is I am working 7 days a week to fit it all in. 

My jobs are so different and they fulfill different passions of mine.
Now when the sports seasons start I may be singing a different tune. My daughters still like having their Mom come to their sporting events, it may be the mere fact that at away games they can get a ride home with me, and a meal on the way back instead of riding home on the bus. I may just not do my evening water aquaweights clases on days of games. I am lucky we have an aquastep class running at the same time so they will have a class to go to. Plus being the boss gives me so much more flexibility at times with scheduling.

Yesterday I took an afternoon just for me. Went to the next town over and had lunch at the Japanese restaurant. Shopped at my favorite stores on the main street of Corning NY. Coffee shop, Simple Styles store for a darling pocketbook, Salvation Army where I scored a Chico's dressy red and black jacket for $2.07 (that may be my bargain of the year, the Travelar series fancy jackets start at $88 on up).

I just feel so blessed by the DS that I have my health and I can do all these things. I even managed to keep up the pace during an autoimmune arthritis flare-up. Thank goodness the water therapy is so amazing, it keeps me going!

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