Advertisement

Surgical Endoscopy

, Volume 23, Issue 10, pp 2385–2389 | Cite as

Two-step laparoscopic duodenal switch for superobesity: a feasibility study

  • Antonio IannelliEmail author
  • Anne Sophie Schneck
  • Moucef Dahman
  • Chiara Negri
  • Jean Gugenheim
Article

Abstract

Background

The laparoscopic duodenal switch (LDS) is a complex bariatric procedure that can be split into two steps to lower the rate of morbidity and mortality. This strategy also identifies patients who do not require the second malabsorptive step to achieve substantial weight loss.

Methods

From October 2005 to January 2008, 77 superobese patients underwent laparoscopic sleeve gastrectomy. The 15 patients (19.5%) who underwent the second step (LDS) up to March 2008 are the subjects of the current study. The indications for the second step were insufficient weight loss (<50% of excess weight [EW]), progressive weight regain, and persistence of comorbidities.

Results

The mean initial body mass index (BMI) was 54 kg/m2 (range, 50.7–59 kg/m2), and the mean EW was 84.8 kg (range, 57–111 kg). There were 21 comorbid conditions experienced by 8 of 15 patients. The two-step procedure resulted in a mean BMI of 39 kg/m2, an excess weight loss (%EWL) of 47.6%, and an excess BMI loss (%EBL) of 51.7% at 1 month. The respective values were 35.6 kg/m2, 57.6%, and 63.4% at 3 months and 33.1 kg/m2, 64.6% and 72% at 6 months. There were no deaths, and only one postoperative complication was recorded (strangulated incisional hernia), for a complication rate of 6.7%. Of the 21 comorbid conditions recorded before surgery, namely, hypertension (n = 6), sleep apnea syndrome (n = 4), diabetes (n = 4), joint disease (n = 3), dyslipidemia (n = 4), hypertension remained unchanged in one case and improved in three cases after the two-step LDS. One patient still needed insulin, but the dose decreased from 500 to 100 IU/day.

Conclusions

Two-step LDS is feasible, safe, and effective. It leads to substantial weight loss and improvement in comorbidities over the short term for superobese individuals.

Keywords

Duodenal switch Laparoscopy Obesity Sleeve gastrectomy Weight loss 

References

  1. 1.
    Scopinaro N, Gianetta E, Civalleri D, Bonalumi U, Bachi V (1979) Bilio-pancreatic bypass for obesity: II. initial experience in man. Br J Surg 66(9):618–620Google Scholar
  2. 2.
    Prachand VN, Davee RT, Alverdy JC (2006) Duodenal switch provides superior weight loss in the superobese (BMI > or =50 kg/m2) compared with gastric bypass. Ann Surg 244:611–619PubMedGoogle Scholar
  3. 3.
    Gagner M, Gumbs AA (2007) Gastric banding: conversion to sleeve, bypass, or DS. Surg Endosc 21:1931–1935CrossRefPubMedGoogle Scholar
  4. 4.
    Gumbs AA, Pomp A, Gagner M (2007) Revisional bariatric surgery for inadequate weight loss. Obes Surg 17:1137–1145PubMedCrossRefGoogle Scholar
  5. 5.
    Anthone GJ, Lord RV, DeMeester TR, Crookes PF (2003) The duodenal switch operation for the treatment of morbid obesity. Ann Surg 238:618–627PubMedGoogle Scholar
  6. 6.
    Anthone GJ (2004) Duodenal switch operation for morbid obesity. Adv Surg 38:293–309PubMedGoogle Scholar
  7. 7.
    Ren CJ, Patterson E, Gagner (2000) Early results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients. Obes Surg 10:514–523CrossRefPubMedGoogle Scholar
  8. 8.
    Iannelli A, Dainese R, Piche T, Facchiano E, Gugenheim J (2008) Laparoscopic sleeve gastrectomy for morbid obesity. World J Gastroenterol 14:821–827CrossRefPubMedGoogle Scholar
  9. 9.
    Regan JP, Inabnet WB, Gagner M, Pomp A (2003) Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the supersuper obese patient. Obes Surg 13:861–864CrossRefPubMedGoogle Scholar
  10. 10.
    Deitel M, Crosby RD, Gagner M (2008) The First International Consensus Summit for Sleeve Gastrectomy (SG), New York City, October 25–27, 2007. Obes Surg 18(5):487–496Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Antonio Iannelli
    • 1
    • 3
    Email author
  • Anne Sophie Schneck
    • 2
    • 3
  • Moucef Dahman
    • 2
    • 3
  • Chiara Negri
    • 2
    • 3
  • Jean Gugenheim
    • 2
    • 3
  1. 1.Service de Chirurgie Digestive et Transplantation HépatiqueHôpital Archet 2NiceFrance
  2. 2.Centre Hospitalier Universitaire de Nice NiceFrance
  3. 3.Faculté de MédecineUniversité de Nice-Sophia-AntipolisNiceFrance

Personalised recommendations