Abstract
Background
In super-super obese (SSO) patients [body mass index (BMI) superior of 60 kg/m2] results of bariatric surgery are still controversial. This study evaluated safety and efficacy of open duodenal switch associated with transitory vertical gastroplasty (DS-TVG) after 8 years of follow-up.
Methods
A prospective observational study of 32 SSO patients who underwent an open DS-TVG from January 1999 till March 2006 was performed. Study endpoints included preoperative comorbidities [diabetes, hypertension, and obstructive sleep apnea syndrome (OSAS)], postoperative morbidity and mortality, and long-term results of BMI and percent of excess weight loss (%EWL) (median 48 months).
Results
Results in terms of BMI and %EWL were, respectively, after 12 months, 46.3 ± 10.2 and 57.1 ± 9.8; after 36 months (n = 21), 37.5 ± 7.5 and 73.5 ± 6.2; and after 84 months (n = 5), 31.7 ± 2.8 and 76.0 ± 4.1. With regard to comorbidities, we observed complete control of lipid alterations and type-2 diabetes (suspension therapy within 1 year). All patients with OSAS improved within 1 year without needing domiciliary oxygen therapy. Neither malnutrition nor mortality was observed during the follow-up. Major complications occurred in a total of 5 patients (15.6%): pulmonary embolism (2 cases—9.4%); gastrointestinal bleeding, requiring transfusions (1 case—3.1%); 1 case (3.1%) of abdominal rupture; and 1 case of acute pancreatitis (3.1%). Minor complications occurred in 4 patients (12.5%): 1 case of pneumonia, 1 urinary tract infection, and 2 wound infections.
Conclusion
Although this study evaluated the outcomes of a small series of patients after open DS-TVG, this procedure seems to be safe and effective in obese patients who have a BMI greater than 60 kg/m2. In our opinion, DS-TVG should be considered as a valid surgical option with two staged laparoscopic procedures.
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References
Miller K. Obesity: surgical options. Best Pract Res Clin Gastroenterol. 2004;18:1147–65.
Vassallo C, Negri L, Della Valle A, et al. Biliopancreatic diversion with transitory gastroplasty preserving duodenal bulb: 3 years experience. Obes Surg. 1997;7:30–3.
Garn SM, Hawthorne VM. The “New” Metropolitan weight tables. Am J Clin Nutr. 1984;39:490–1.
De Maria EJ, Schauer P, Patterson E, et al. The optimal surgical management of the super-obese patient: the debate. Surg Innov. 2005;12:107–21.
Watkins BM, Montgomery KF, Ahroni JH, et al. Laparoscopic adjustable gastric banding: early experience in 400 consecutive patients in the USA. Obes Surg. 2005;15:82–7.
Rubino F, Marescau J. Effect of duodenal–jejunal exclusion in a non obese animal model of type 2 diabetes: a new perspective for an old disease. Ann Surg. 2004;239:1–11.
Taylor JD, Leitman IM, Hon P, et al. Outcome and complications of gastric bypass in super-super obesity versus morbid obesity. Obes Surg. 2006;16:16–8.
Farkas DT, Vemulapalli P, Haider A, et al. Laparoscopic Roux-en-Y gastric bypass is safe and effective in patients with a BMI ≥60. Obes Surg. 2005;15:486–93.
Oliak D, Ballantyne GH, Davies RH, et al. Short-term results of laparoscopic gastric bypass in patients with BMI > or =60. Obes Surg. 2002;12:643–47.
Regan JP, Inabnet WB, Gagner M, et al. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg. 2003;13:861–64.
Shauer P. Gastric bypass for severe obesity: approaches and outcomes. Surg Obes Relat Dis. 2005;1:297–300.
Tichansky DS, DeMaria EJ, Fernandez AZ, et al. Postoperative complications are not increased in super-super obese patients who undergo laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2005;19:939–41.
Raijman I, Strother SV, Donegan WL. Gastric cancer after gastric bypass for obesity. J Clin Gastroenterol. 1991;13:191–4.
Escalona A, Guzman S, Ibanez L, et al. Gastric cancer after Roux-en-Y gastric bypass. Obes Surg. 2005;15:423–7.
Lord R, Edwards P, Coleman M, et al. Gastric cancer in the bypassed segment after operation for morbid obesity. Aust N Z J Surg. 1997;67:580–2.
Khitin L, Roses R, Birkett D. Cancer in the gastric remnant after gastric bypass. Curr Surg. 2003;60:521–3.
Calle E, Rodriguez C, Walker-Thurmond K, et al. Overweight obesity and mortality from cancer in a prospectively studied cohort of U.S.: adults. N Engl J Med. 2003;348:1625–38.
Cottam DR, Mattar SG, Barinas-Mitchell E, et al. The chronic inflammatory hypotesis for the morbidity associated with morbid obesity: implications and effects of weight loss. Obes Surg. 2004;14:589–600.
Hess DS, Hess DW, Oakley RS. The biliopancreatic diversion with duodenal switch: results beyond 10 years. Obes Surg. 2005;15:408–16.
Mittempergher F, Bruni T, Bruni O, et al. Biliopancreatic diversion with preservation of duodenal bulb and transitory gastroplasty in the treatment of morbid obesity. Our experience. Ann Ital Chir. 2002;73:137–42.
Di Betta E, Mittempergher F, Di Fabio F, et al. Duodenal switch without gastric resection after failed gastric restrictive surgery for morbid obesity. Obes Surg. 2006;16:258–61.
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Di Betta, E., Mittempergher, F., Nascimbeni, R. et al. Outcome of Duodenal Switch with a Transitory Vertical Gastroplasty, in Super-Super-Obese Patients in an 8-Year Series. OBES SURG 18, 182–186 (2008). https://doi.org/10.1007/s11695-007-9293-x
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DOI: https://doi.org/10.1007/s11695-007-9293-x