Duodenal Switch

Abstract

Duodenal switch (DS) consists of a pylorus-preserving limited vertical gastrectomy and distal biliopancreatic bypass with a common channel of 65-100 cm. From March 1994 to June 2003, 482 patients underwent DS. Open surgery was used in 381 and laparoscopy in 99. Eighty-four percent were women. Fifty-two percent were superobese and there were 35 conversions from a previous bariatric technique. The initial mean weight was 137 kg (range: 93-270) and the mean BMI was 51.56 kg/m 2 (range: 37-100) Of the patients who underwent open surgery, 35 (9.18%) presented severe complications with 22 anastomotic leaks (5.77%), of which half were duodenal- ileal. Twenty reinterventions were required. Two patients died from multiorgan failure secondary to leaks and one patient died from pulmonary thromboembolism (overall operative mortality: 0.78%). Among patients undergoing laparoscopic DS, six required conversion to open surgery. There were three leaks, with one death (mortality: 1.01%) and 10 reinterventions. Six patients (1.25%) required intestinal lengthening due to diarrhea or hypoproteinemia. The mean percentage of excess weight lost was 90% at 5 years among the morbidly obese and was 70% among the superobese with a final BMI of 27 and 37 kg/m 2 , respectively. Comorbidity substantially improved. Regarding quality of life, more than 90% tolerated all types of food. Stool frequency caused annoyance or was intolerable in 20% of the patients.