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Annals of Surgery:
doi: 10.1097/SLA.0b013e318188e1c2
Original Articles

Duodenal Switch Operative Mortality and Morbidity Are Not Impacted by Body Mass Index

Buchwald, Henry MD, PhD; Kellogg, Todd A. MD; Leslie, Daniel B. MD; Ikramuddin, Sayeed MD

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Abstract

Objective: This report examines the ≤30-day postoperative mortality and morbidity in our first 190 duodenal switch (DS) patients.

Background Data: DS is the most weight loss effective and the most difficult to perform bariatric procedure. Indeed, certain surgeons have advocated a 2-stage approach to minimize complications, especially in the super obese (body mass index [BMI] ≥50 kg/m2).

Methods: DS procedures were performed (n = 190) by either open (n = 168) or laparoscopic/robotic surgery in an academic setting: common channel 75 to 125 cm, sleeve gastrectomy (∼100 mL gastric pouch), closed duodenal stump, end-to-side duodenoileostomy hand-sewn in 2 layers, with most staple lines oversewn, and all mesentery defects closed.

Results: For the 190 patients, 149 were female (78%) and the mean age was 43 years (range, 16–71). Mean preoperative weight 151.4 kg (range, 74.1–332.7); mean preoperative BMI 53.4 kg/m2 (range, 32–107), with 100 (52.6%) of the patients super obese (BMI ≥50 kg/m2). Seventy-four patients had concurrent procedures, eg, cholecystectomy (n = 22), ventral or umbilical hernia repair (n = 19), and hiatus hernia repair (n = 10). Mean operating room time was 337 minutes (range, 127–771); mean hospitalization time was 6 days (range, 2–38). There were no deaths. Serious ≤30-day complications (n = 18 in 14 patients) consisted of 2 leaks (1.0%), which responded to drainage, and intra-abdominal bleeding (n = 3), splenectomy (n = 1), acute pancreatitis (n = 2), gastric outlet obstruction (n = 1), acute renal failure (n = 2), pneumonia (n = 2), respiratory failure (n = 3), acute myocardial infarction (n = 1), and duodenoileostomy stricture requiring endoscopic dilation (n = 1). The serious complication rate in patients with a BMI <50 kg/m2 was 6.7% (6 of 90) and 12% (12 of 100) with a BMI ≥50 kg/m2 (NS). Surgical site infections occurred in 7 patients with a BMI <50 kg/m2 and in 12 with a BMI ≥50 kg/m2 (NS). Overall complication rate in patients with a BMI <50 kg/m2 was 14.4% (13 of 90) and 24% (24 of 100) with a BMI ≥50 kg/m2 (NS).

Conclusions: With attention to careful surgical technique, DS can be performed relatively safely in the morbidly and super morbidly obese, and does not require a 2-stage procedure.

© 2008 Lippincott Williams & Wilkins, Inc.

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