Sarah Sabrudin

The incidence of complications associated with loop duodeno-ileostomy after single-anastomosis duodenal switch procedures among 1328 patients: a multicenter experience

BACKGROUND The single-anastomosis duodenal switch procedure is a type of duodenal switch that involves a loop anastomosis rather than traditional Roux-en-Y reconstruction. To date, there have been no multicenter studies looking at the complications associated with post-pyloric loop reconstruction. OBJECTIVES The aim of the study was to report the incidence of complications associated with loop duodeno-ileostomy (DI) following single-anastomosis duodenal switch (SADS) procedures. SETTING Mixed of private and teaching facilities. METHODS The medical records of 1328 patients who underwent primary SADS procedure (single-anastomosis duodeno-ileal bypass with sleeve gastrectomy or stomach intestinal pylorus-sparing surgery) by 17 surgeons from 3 countries (United States, Spain, and Australia) at 9 centers over a 6-year period were retrospectively reviewed, and their results were compared with articles in the literature. RESULTS Mean preoperative body mass index was 51.6 kg/m2. Of 1328 patients, 123 patients received a linear stapled duodeno-ileostomy (DI) and 1205 patients a hand-sewn DI. In the overall series, the anastomotic leak, ulcer, and bile reflux occurred in .6% (9/1328), .1% (2/1328), and .1% (2/1328), respectively. None of our patients experienced volvulus at the DI or an internal hernia. Overall, 5 patients (.3%) (3/123 [2.4%] with linear stapled DI versus 2/1205 [.1%] with hand-sewn DI [P<.05]) experienced stricture at the DI in this series. CONCLUSIONS The overall incidence of complications associated with loop DI was lower than the reported incidence of anastomotic complications after Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch. SADS procedures may cause much fewer anastomotic complications compared with Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch.

Acute and Chronic Complications Following Biliopancreatic Diversion with Duodenal Switch

Duodenal switch is a procedure that offers patients a higher average weight loss than other more commonly performed bariatric procedures. However, it is technically challenging, and patients have an increased risk of complications from the longer intestinal bypass. The purpose of this chapter is to explain the evolution of the operation and technical considerations and describe the complications that can arise and their management. The importance is paramount, as it is expected that DS and its modifications will grow in favor and become more commonly offered procedures.

Conversion and Revisional Surgery: Duodenal Switch

Duodenal switch (DS) and its modifications, including modified duodenal switch (MDS), stomach intestinal pylorus-sparing surgery (SIPS), and single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S), offer greater weight loss and resolution of metabolic syndrome than more commonly performed bariatric procedures [1]. Therefore, when patients have inadequate weight loss or weight regain following laparoscopic adjustable gastric banding (LAGB), vertical sleeve gastrectomy (VSG), or Roux-en-Y gastric bypass (RYGB), conversion to DS is a veritable and enticing option that offers the greatest likelihood of sustained weight loss. Though DS may optimize weight loss in these patients, these procedures confer a higher risk of frequent bowel movements, diarrhea, and deficiencies of protein and micronutrients. When symptomatic and extreme, these adverse effects require surgical revision. This chapter reviews the evidence and techniques for revision of other bariatric operations to DS as well as techniques to modify the DS when complications such as malnutrition arise.