1: Obes Surg. 2008 Mar 12

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 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 successful with an appropriate system of follow-up.

Source: "Duodenal Switch: Long-Term Results"