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A Matched Cohort Analysis of Sleeve Gastrectomy With and Without 300 cm Loop Duodenal Switch With 18-Month Follow-Up

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Abstract

Background

In bariatric surgery, a significant question remains unanswered—What proportion of weight loss comes from each component and does this differ with time? Single anastomosis duodenal switch (LDS) combines a vertical sleeve gastrectomy (VSG) with a loop attachment of the duodenal stump. There are two major variables the sleeve, and the intestine that processes ingested food. A comparison of patients that had a VSG with those that have had a LDS approximates the contribution of each component.

Methods

A retrospective matched cohort analysis of VSG and LDS patients was obtained by matching every LDS patient to a VSG patient of the same sex and BMI. Excess weight lost percentage (%EWL) and the total weight loss percentage (%TWL) was analyzed. The data was compared through descriptive statistics and non-linear regression analysis.

Results

Over 18 months, patients who received the LDS lost more %TWL and %EWL and the difference was statistically significant (p < 0.05). Additionally, with time, the difference became more profound. Weight loss stabilized at approximately 9–12 months and 15 to 18 for VSG and LDS patients’, respectively. At 6 months post op, there was approximately 13 % difference in weight loss. This increased to 29 % difference at 18 months.

Conclusion

LDS patients lose more weight than VSG. Preserving 3 m of intestinal length adds 30 % greater weight loss at 18 months. Early weight loss is similar between the two operations, while the intestinal component becomes more important with weight loss differentials increasing as time since surgery lengthens.

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Authors and Affiliations

  1. Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA

    Austin Cottam, Daniel Cottam, Samuel Cottam, Walter Medlin, Christina Richards, Amit Surve & Hinali Zaveri

  2. Lenox Hill Hospital, 100 E 77th Street, New York, NY, 10075, USA

    Mitchell Roslin

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  1. Austin Cottam
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  2. Daniel Cottam
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  3. Mitchell Roslin
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  4. Samuel Cottam
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  6. Christina Richards
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  7. Amit Surve
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  8. Hinali Zaveri
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Correspondence to Daniel Cottam.

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Conflict of Interest

Austin Cottam has no conflicts of interest to declare.

Daniel Cottam the corresponding author reports personal fees and other from Medtronic, outside the submitted work.

Mitchell Roslin reports personal fees and other from Medtronic, outside the submitted work.

Samuel Cottam has no conflicts of interest to declare.

Walter Medlin has no conflicts of interest to declare.

Christina Richards has no conflicts of interest to declare.

Amit Surve has no conflicts of interest to declare.

Hinali Zaveri has no conflicts of interest to declare.

Statement of Human and Animal Rights

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.

Since this is a retrospective study: formal consent is not required for this type of study.

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Cottam, A., Cottam, D., Roslin, M. et al. A Matched Cohort Analysis of Sleeve Gastrectomy With and Without 300 cm Loop Duodenal Switch With 18-Month Follow-Up. OBES SURG 26, 2363–2369 (2016). https://doi.org/10.1007/s11695-016-2133-0

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  • DOI: https://doi.org/10.1007/s11695-016-2133-0

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