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Long Alimentary Limb Duodenal Switch (LADS): an Exploratory Randomized Trial, Results at 2 Years

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Abstract

Purpose

The effectiveness of the standard biliopancreatic diversion with duodenal switch (BPD/DS) in terms of weight loss has been demonstrated. Increasing the strict alimentary limb length while maintaining the length of the common channel could lead to similar weight loss while reducing side effects.

Materials and Methods

The objective was to evaluate the effect of increasing the strict alimentary limb length on weight loss, comorbidities, nutritional deficiencies, and quality of life 2 years after surgery, compared with standard BPD/DS. An exploratory randomized, double-blind study evaluated the results of LADS at 2 years in comparison with the standard BPD/DS. Common channel was kept at 100 cm in both groups while alimentary limb was created at 100 cm from Treitz angle in the LADS group and at 150 cm total in the BPD/DS group.

Results

Twenty patients were recruited from May 2013 to June 2015. Mean percentage of excess weight loss was statistically significantly lower in the LADS group at 24 months (81.6 ± 6.6% in the LADS group and 97.1 ± 11.1% in the BPD/DS group (p = 0.001). No significant difference regarding the rate of remission of comorbidities was noted. Mean calcium, vitamin D, hemoglobin, zinc, and copper levels were statistically lower in the BPD/DS group. Quality of life was significantly improved in both groups, with no statistically significant difference between the two groups.

Conclusions

At 24 months, weight loss was lower in the LADS group. However, no difference was observed in the improvement in quality of life. LADS technique was discontinued following this study.

Trial registration

ClinicalTrial.gov Ref. NCT03097926

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Abbreviations

LADS:

Long alimentary limb duodenal switch

BPD/DS:

Biliopancreatic diversion with duodenal switch

BMI:

Body mass index

EWL:

Excess weight loss

EWL%:

Percentage of excess weight loss

NIH:

National Institutes of Health

SG:

Sleeve gastrectomy

CPAP:

Continuous positive airway pressure

HDL:

High-density lipoprotein

TWL%:

Percentage of total weight loss

SIPS:

Stomach intestinal pylorus sparing surgery

OADS:

One-anastomosis duodenal switch

kg/m2 :

Kilogram per meter squared

kg:

Kilogram

%:

Percentage

N:

Number

CVD:

Cardiovascular disease

T2D:

Type 2 diabetes

COPD:

Chronic obstructive pulmonary disease

HTN:

Arterial hypertension

g/L:

Gram per liter

mM:

Millimole

ng/L:

Nanogram per liter

μM:

Micromole

μg/L:

Microgram per liter

mg:

Milligram

IU:

International unit

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Acknowledgments

The authors thank IUCPQ’s foundation for their support to this work.

Funding

Research grant from the Fondation de l’Institut universitaire de cardiologie et pneumologie de Quebec, Université Laval

Author information

Authors and Affiliations

  1. Department of surgery, Centre hospitalier universitaire de Sherbrooke – Université de Sherbrooke, Sherbrooke, Québec, Canada

    François-Charles Malo, Andréanne Marion & Antoine Rioux

  2. Department of surgery, Institut universitaire de cardiologie et pneumologie de Québec – Université Laval, Québec, Canada

    François-Charles Malo, Stéfane Lebel, Frédéric Hould, François Julien, Simon Marceau, Odette Lescelleur, Annie Lafortune, Léonie Bouvet-Bouchard & Laurent Biertho

Authors
  1. François-Charles Malo
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  2. Andréanne Marion
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  3. Antoine Rioux
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  4. Stéfane Lebel
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  5. Frédéric Hould
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  6. François Julien
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  7. Simon Marceau
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  8. Odette Lescelleur
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  9. Annie Lafortune
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  10. Léonie Bouvet-Bouchard
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  11. Laurent Biertho
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Corresponding author

Correspondence to François-Charles Malo.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethics Declarations

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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Informed consent was obtained from all individual participants included in the study.

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Malo, FC., Marion, A., Rioux, A. et al. Long Alimentary Limb Duodenal Switch (LADS): an Exploratory Randomized Trial, Results at 2 Years. OBES SURG 30, 5047–5058 (2020). https://doi.org/10.1007/s11695-020-04968-5

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  • DOI: https://doi.org/10.1007/s11695-020-04968-5

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