Duodenal Switch: Long-Term Results
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- Marceau, P., Biron, S., Hould, FS. et al. OBES SURG (2007) 17: 1421. doi:10.1007/s11695-008-9435-9
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This report summarizes our 15-year experience with duodenal switch (DS) as a primary procedure on 1,423 patients from 1992 to 2005.
Within the last 2 years, follow-up of these patients, including clinical biochemistry evaluation by us or by their local physician is 97%.
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.
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.