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Management of Malnutrition and Hepatic Impairment After Duodenal Switch

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Abstract

Background

Malnutrition and liver impairment after duodenal switch (DS) are possible and undesired complications, often conservatively treated. However, in specific cases, surgical revision may be necessary. This study aims to describe outcomes achieved by two bariatric surgery centers and address effectiveness and safety of revisional surgical procedures to resolve these complications.

Methods

A retrospective chart review was performed in two bariatric surgery centers from 2008 to 2022. Patients who required revisional surgery to treat malnutrition and/or liver impairment refractory to nutritional and total parenteral nutrition intervention (TPN) after duodenal switch were included. No comparisons were performed due to the descriptive nature of this study.

Results

Thirteen patients underwent revisional surgery, the mean age was 44.7, the 53.8% were females, and the mean preoperative BMI was 54.7 kg/m2; the mean time between DS and revisional procedure was 26.5 months, and 69.1% of patients were placed on TPN. One patient developed hepatic encephalopathy; one patient presented with ascites, pleural effusion, and renal insufficiency, undergoing reoperation after revisional procedure due to a perforated ileal loop. Mortality rate was 0%; all patients regained weight after the revisional procedure, and the mean total protein and albumin blood levels 12 months after surgery were 6.3 and 3.6 g/dl, respectively.

Conclusions

While refractory malnutrition and/or liver failure are rare among patients post-DS, if underdiagnosed and untreated, this can lead to irreversible outcomes and death. All revisional procedures included in this study resulted in improvement of the nutritional status and reversal of liver impairment, with low complication rates.

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Data Availability

The data that support the findings of this study are on a repository; they are not publicly available because it contains information that could compromise the privacy of research participants.

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Authors and Affiliations

  1. Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, 1st Floor, Orlando, FL, USA

    Romulo P. Lind, Muhammad Ghanem, Muhammad A. Jawad & Andre F. Teixeira

  2. Department of Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA

    Marita Salame, Michael Kendrick & Omar M. Ghanem

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  1. Romulo P. Lind
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  2. Marita Salame
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  3. Michael Kendrick
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  4. Muhammad Ghanem
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  5. Muhammad A. Jawad
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  6. Omar M. Ghanem
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  7. Andre F. Teixeira
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Correspondence to Romulo P. Lind.

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The authors declare no competing interests.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Key Points

• Malnutrition and liver impairment after DS rarely require surgical intervention.

• Lengthening of the common channel, conversion to RYGB, and “kissing X” procedure were performed.

• All procedures were effective at reversing complications, with 0% mortality.

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Lind, R.P., Salame, M., Kendrick, M. et al. Management of Malnutrition and Hepatic Impairment After Duodenal Switch. OBES SURG 34, 602–609 (2024). https://doi.org/10.1007/s11695-023-07032-0

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  • DOI: https://doi.org/10.1007/s11695-023-07032-0

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