Stéfane Lebel1, Geneviève Dion2, Simon Marceau2, Simon Biron2, Maud Robert2, Laurent Biertho2. 1. Institut Universitaire de Cardiologie et de Pneumologie de Québec, Department of Surgery, Division of Bariatric and General Surgery, Laval University, Quebec City, Quebec, Canada. Electronic address: stefanelebel@gmail.com. 2. Institut Universitaire de Cardiologie et de Pneumologie de Québec, Department of Surgery, Division of Bariatric and General Surgery, Laval University, Quebec City, Quebec, Canada.
Abstract
BACKGROUND:Biliopancreatic diversion with duodenal switch (BPD-DS) with a 100-cm common channel has been our treatment of choice for morbid obesity since the early 1990s. This procedure offers excellent long-term weight loss but can be associated with significant side effects. OBJECTIVES: To assess the effect on clinical and nutritional parameters of increasing the common channel to 200 cm. SETTINGS: University-affiliated tertiary care center. METHODS:Patients who underwent a BPD-DS with a 200-cm common channel (study group, n = 36) were matched 1:1 for age, sex, body mass index (BMI), and main co-morbidities with patients who underwent a BPD-DS with a 100-cm common channel (control group). The strict alimentary limb was 150 cm in both groups. RESULTS:The mean age was 55±9 versus 53±7 years (P = .3), with 50% women and a BMI of 49±8 kg/m(2) versus 50±6 kg/m(2) (P = .9). Follow-up rate was 97%, with a minimum follow-up of 3 years. There were no significant differences in the remission rate of major co-morbidities between the 2 groups. At 3 years, the excess weight loss was 61±22% versus 68±18% (P = .18) and the total weight loss was 33±11% versus 38±9% (P = .055) in the study group versus control group, respectively. The study group had a lower incidence of severe protein deficiency (11% versus 19%, P = .3) and hyperparathyroidism (17.1% versus 35.3%, P = .17); required a lower amount of vitamins A and D (P<.05); and had a decreased number of daily bowel movements (2.0 versus 2.9, P = .03). CONCLUSION: In this population, BPD-DS with a 200-cm common channel offered similar remission rate of co-morbidities compared with standard BPD-DS. It was associated with similar weight loss at nadir, followed by a more significant weight regain. It might yield a lower rate of nutritional complications. Long-term randomized data are needed to detect other potential advantages.
RCT Entities:
BACKGROUND: Biliopancreatic diversion with duodenal switch (BPD-DS) with a 100-cm common channel has been our treatment of choice for morbid obesity since the early 1990s. This procedure offers excellent long-term weight loss but can be associated with significant side effects. OBJECTIVES: To assess the effect on clinical and nutritional parameters of increasing the common channel to 200 cm. SETTINGS: University-affiliated tertiary care center. METHODS:Patients who underwent a BPD-DS with a 200-cm common channel (study group, n = 36) were matched 1:1 for age, sex, body mass index (BMI), and main co-morbidities with patients who underwent a BPD-DS with a 100-cm common channel (control group). The strict alimentary limb was 150 cm in both groups. RESULTS: The mean age was 55±9 versus 53±7 years (P = .3), with 50% women and a BMI of 49±8 kg/m(2) versus 50±6 kg/m(2) (P = .9). Follow-up rate was 97%, with a minimum follow-up of 3 years. There were no significant differences in the remission rate of major co-morbidities between the 2 groups. At 3 years, the excess weight loss was 61±22% versus 68±18% (P = .18) and the total weight loss was 33±11% versus 38±9% (P = .055) in the study group versus control group, respectively. The study group had a lower incidence of severe protein deficiency (11% versus 19%, P = .3) and hyperparathyroidism (17.1% versus 35.3%, P = .17); required a lower amount of vitamins A and D (P<.05); and had a decreased number of daily bowel movements (2.0 versus 2.9, P = .03). CONCLUSION: In this population, BPD-DS with a 200-cm common channel offered similar remission rate of co-morbidities compared with standard BPD-DS. It was associated with similar weight loss at nadir, followed by a more significant weight regain. It might yield a lower rate of nutritional complications. Long-term randomized data are needed to detect other potential advantages.
Authors: Fernanda R Azevedo; Sergio Santoro; Maria L Correa-Giannella; Marcos T Toyoshima; Daniel Giannella-Neto; Daniela Calderaro; Danielle M Gualandro; Pai C Yu; Bruno Caramelli Journal: Obes Surg Date: 2018-10 Impact factor: 4.129
Authors: Ramon Vilallonga; José Maria Balibrea; Anna Curell; Oscar Gonzalez; Enric Caubet; Andrea Ciudin; Angel Michael Ortiz-Zúñiga; José Manuel Fort Journal: Obes Surg Date: 2017-12 Impact factor: 4.129