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Laparoscopic Duodenal Switch Versus Roux-en-Y Gastric Bypass at a High-Volume Community Hospital: a Retrospective Cohort Study from a Rural Setting

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Abstract

Background

The classic duodenal switch (DS) represents a minority of bariatric procedures due to its high complexity and potential for complications.

Methods

A retrospective chart review was conducted on 100 laparoscopic DS cases from 2014 to 2018 at an accredited program in a rural community hospital and compared to 100 laparoscopic Roux-en-Y gastric bypasses (RYGB). Primary outcomes were 30-day morbidity and mortality. Secondary outcomes included anastomotic leak and remission of type 2 diabetes.

Results

There were more demographic risk factors for DS. The 30-day morbidity was higher for DS compared to RYGB (31% vs 13%, respectively; p = 0.0037). There was one mortality for DS and none for RYGB. There were statistically significant longer intraoperative times, greater EBL, and greater decrease in BMI for DS. The DS had a lower incidence of anastomotic ulcers (4% vs 13%, respectively; p = 0.0289), with a higher incidence of subsequent surgery beyond 30 days (21% vs 8%, respectively; p = 0.0160). There were 3 anastomotic leaks for DS and none for RYGB, although not statistically significant (p = 0.2463). The DS was more likely to eradicate hypertension, but the RYGB was more likely to eradicate GERD. There were no statistically significant differences for type 2 diabetes remission (92.1% vs 89.5%, respectively; p = 0.7239).

Conclusion

Laparoscopic DS offers greater weight loss and hypertension remission, with lower incidence of anastomotic ulcers, but at the expense of greater morbidity and need for subsequent surgery, with no significant differences in type 2 diabetes remission when compared to RYGB in a rural community hospital program.

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Authors and Affiliations

  1. Houston Methodist Hospital, Department of Surgery, 6550 Fannin St., SM 1661, Houston, TX, 77030, USA

    Rodolfo J. Oviedo

  2. George Washington University, Department of Statistics, 801 22nd St NW, Washington, DC, 20052, USA

    Tapan Nayak, Yang Liu, Shixue Zhang & Fengyu Zhao

Authors
  1. Rodolfo J. Oviedo
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  2. Tapan Nayak
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  3. Yang Liu
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  4. Shixue Zhang
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  5. Fengyu Zhao
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Corresponding author

Correspondence to Rodolfo J. Oviedo.

Ethics declarations

The chart review was performed with Institutional Review Board (IRB) approval from the Ethics Committee of Winchester Medical Center, a 495-bed acute care hospital in the Shenandoah Valley of Virginia, USA. For this type of retrospective study, formal consent is not required. Informed consent for the retrospective chart review did not apply.

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The authors declare that they have no conflict of interest.

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Oviedo, R.J., Nayak, T., Liu, Y. et al. Laparoscopic Duodenal Switch Versus Roux-en-Y Gastric Bypass at a High-Volume Community Hospital: a Retrospective Cohort Study from a Rural Setting. OBES SURG 31, 659–666 (2021). https://doi.org/10.1007/s11695-020-05026-w

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  • DOI: https://doi.org/10.1007/s11695-020-05026-w

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