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The use of a total bowel length measurement protocol may reduce reoperations and complications after single-anastomosis duodenal switch

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Abstract

Introduction

Most surgeons who perform single-anastomosis duodeno-ileal switches (SADI-S) use a pre-determined common channel length without measuring total bowel length (TBL). However, TBL varies between patients, and a standardized common channel length could contribute to malabsorptive complications and reoperations following SADI-S. The purpose of this study was to determine whether using a TBL measurement protocol to individualize common channel length would be associated with reduced reoperations and complications.

Methods

A prospectively maintained data registry was retrospectively reviewed to identify all patients who underwent SADI-S between September 2017 and February 2022. In April 2021, we began using TBL measurements during SADI-S with 40% of the TBL used as the length for the common channel. Outcomes pre-TBL and post-TBL measurement protocol were compared.

Results

A total of 119 SADI-S recipients (59 pre-TBL; 60 post-TBL) were included. The pre-TBL group had a higher frequency of reoperations (23.7% vs 1.7%, p < 0.001) and late complications (29.3% vs 3.3%, p < 0.001). The mean time to reoperation was 13.7 months in the pre-TBL group and 6.7 months in the post-TBL group (p = 0.347). Patients in the post-TBL group had significantly higher serum albumin levels at 3 months (4.2 g/dL vs 3.5 g/dL, p < 0.001), 6 months (4.1 g/dL vs 3.6 g/dL, p < 0.001), and 12 months (4.2 g/dL vs 3.8 g/dL, p = 0.023) postoperatively when compared to the pre-TBL group.

Conclusion

Using TBL measurements to individualize common channel length was associated with a significant reduction in reoperations and late complications following SADI-S.

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Authors and Affiliations

  1. Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA

    Lucas Fair, Anthony C. Waddimba, Phillip Strothman, Steven Leeds & Daniel Davis

  2. Center for Medical and Weight Loss Management, Baylor University Medical Center, Dallas, TX, USA

    Daniel Davis

  3. Baylor Scott and White Research Institute, Dallas, TX, USA

    Lucas Fair, Anthony C. Waddimba, Anella Bittle & Gerald O. Ogola

  4. Health Sciences Center, College of Medicine, Texas A&M University, Dallas, TX, USA

    Darby Dwyer, Priscilla Anderton, Steven Leeds & Daniel Davis

  5. Center for Advanced Surgery, Baylor University Medical Center, Dallas, TX, USA

    Steven Leeds

  6. Center for Metabolic and Weight Loss Surgery, Baylor University Medical Center at Dallas, Dallas, TX, USA

    Daniel Davis

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  1. Lucas Fair
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All authors listed above contributed to this manuscript and meet the requirements of appropriate authorship as defined by the International Committee of Medical Journal Editors (ICMJE).

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Correspondence to Daniel Davis.

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Disclosures

Daniel Davis is a consultant for Intuitive Surgical Inc. Lucas Fair, Anthony Waddimba, Phillip Strothman, Darby Dwyer, Priscilla Anderton, Anella Bittle, Gerald Ogola, and Steven Leeds have no conflicts of interest or financial ties to disclose.

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Fair, L., Waddimba, A.C., Strothman, P. et al. The use of a total bowel length measurement protocol may reduce reoperations and complications after single-anastomosis duodenal switch. Surg Endosc 37, 9310–9317 (2023). https://doi.org/10.1007/s00464-023-10505-z

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