The Duodenal Switch Operation for the Treatment of Morbid Obesity

Gary J. Anthone, Reginald V N Lord, Tom R. DeMeester, Peter F. Crookes, Michael G. Sarr, Carlos A. Pellegrini, Robert J. Fitzgibbons

Research output: Contribution to journalArticle

122 Citations (Scopus)

Abstract

Obj ective: To determine the safety and efficacy of the duodenal switch procedure as surgical treatment of morbid obesity. Summary Background Data: The longitudinal gastrectomy and duodenal switch procedure as performed for morbid obesity involves a 75% subtotal greater curvature gastrectomy and long limb suprapapillary Roux-en-Y duodenoenterostomy. This results in a restricted caloric intake and diversion of bile and pancreatic secretions to induce fat malabsorption. Broad acceptance of this procedure has been impeded because of concerns that the malabsorptive component may produce serious nutritional complications. Methods: Review of data collected prospectively from all patients who underwent duodenal switch as the primary surgical treatment of morbid obesity at a single institution during the 10-year period beginning September 1992. Operative morbidity and mortality, weight loss, volume of food intake, and bowel function were recorded. Sequential measurements of serum albumin, hemoglobin, and calcium levels were obtained to assess metabolic function and nutrient absorption. Results: Duodenal switch was performed as the primary operation in 701 (81%) of a total 863 patients undergoing bariatric surgery during the period of study. The average body mass index (BMI) was 52.8 (range, 34-95). Perioperative mortality was 1.4%, and morbidity (including leaks, wound dehiscence, splenectomy, and postoperative hemorrhage) occurred in 21 patients (2.9%). Weight loss averaged 127 pounds at 1 year, 131 at 3 years, and 118 at 5 or more years (% EBWL of 69%, 73%, and 66%, respectively). The mean number of bowel movements was fewer than 3 per day. Patients reported and maintained a mean restriction of 63% of their preoperative intake (approximately 1600 calories), with no specific food intolerance, at 3 or more years follow-up. At 3 years, serum albumin remained at normal levels in 98% of patients, hemoglobin in 52%, and calcium in 71%. No patients reported dumping, and marginal ulcers were not seen. Conclusions: The longitudinal gastrectomy with duodenal switch is a safe and effective primary procedure for the treatment of morbid obesity. It has the advantage of allowing acceptable alimentation with a minimum of side effects while producing and maintaining significant weight loss. These results are achieved without developing significant dietary restrictions or clinical metabolic or nutritional complications.

Original languageEnglish
Pages (from-to)618-628
Number of pages11
JournalAnnals of Surgery
Volume238
Issue number4
StatePublished - Oct 2003

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Morbid Obesity
Gastrectomy
Weight Loss
Serum Albumin
Hemoglobins
Calcium
Morbidity
Therapeutics
Patient Transfer
Food
Postoperative Hemorrhage
Bariatric Surgery
Mortality
Splenectomy
Energy Intake
Peptic Ulcer
Bile
Body Mass Index
Extremities
Eating

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Anthone, G. J., Lord, R. V. N., DeMeester, T. R., Crookes, P. F., Sarr, M. G., Pellegrini, C. A., & Fitzgibbons, R. J. (2003). The Duodenal Switch Operation for the Treatment of Morbid Obesity. Annals of Surgery, 238(4), 618-628.

The Duodenal Switch Operation for the Treatment of Morbid Obesity. / Anthone, Gary J.; Lord, Reginald V N; DeMeester, Tom R.; Crookes, Peter F.; Sarr, Michael G.; Pellegrini, Carlos A.; Fitzgibbons, Robert J.

In: Annals of Surgery, Vol. 238, No. 4, 10.2003, p. 618-628.

Research output: Contribution to journalArticle

Anthone, GJ, Lord, RVN, DeMeester, TR, Crookes, PF, Sarr, MG, Pellegrini, CA & Fitzgibbons, RJ 2003, 'The Duodenal Switch Operation for the Treatment of Morbid Obesity', Annals of Surgery, vol. 238, no. 4, pp. 618-628.
Anthone GJ, Lord RVN, DeMeester TR, Crookes PF, Sarr MG, Pellegrini CA et al. The Duodenal Switch Operation for the Treatment of Morbid Obesity. Annals of Surgery. 2003 Oct;238(4):618-628.
Anthone, Gary J. ; Lord, Reginald V N ; DeMeester, Tom R. ; Crookes, Peter F. ; Sarr, Michael G. ; Pellegrini, Carlos A. ; Fitzgibbons, Robert J. / The Duodenal Switch Operation for the Treatment of Morbid Obesity. In: Annals of Surgery. 2003 ; Vol. 238, No. 4. pp. 618-628.
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abstract = "Obj ective: To determine the safety and efficacy of the duodenal switch procedure as surgical treatment of morbid obesity. Summary Background Data: The longitudinal gastrectomy and duodenal switch procedure as performed for morbid obesity involves a 75{\%} subtotal greater curvature gastrectomy and long limb suprapapillary Roux-en-Y duodenoenterostomy. This results in a restricted caloric intake and diversion of bile and pancreatic secretions to induce fat malabsorption. Broad acceptance of this procedure has been impeded because of concerns that the malabsorptive component may produce serious nutritional complications. Methods: Review of data collected prospectively from all patients who underwent duodenal switch as the primary surgical treatment of morbid obesity at a single institution during the 10-year period beginning September 1992. Operative morbidity and mortality, weight loss, volume of food intake, and bowel function were recorded. Sequential measurements of serum albumin, hemoglobin, and calcium levels were obtained to assess metabolic function and nutrient absorption. Results: Duodenal switch was performed as the primary operation in 701 (81{\%}) of a total 863 patients undergoing bariatric surgery during the period of study. The average body mass index (BMI) was 52.8 (range, 34-95). Perioperative mortality was 1.4{\%}, and morbidity (including leaks, wound dehiscence, splenectomy, and postoperative hemorrhage) occurred in 21 patients (2.9{\%}). Weight loss averaged 127 pounds at 1 year, 131 at 3 years, and 118 at 5 or more years ({\%} EBWL of 69{\%}, 73{\%}, and 66{\%}, respectively). The mean number of bowel movements was fewer than 3 per day. Patients reported and maintained a mean restriction of 63{\%} of their preoperative intake (approximately 1600 calories), with no specific food intolerance, at 3 or more years follow-up. At 3 years, serum albumin remained at normal levels in 98{\%} of patients, hemoglobin in 52{\%}, and calcium in 71{\%}. No patients reported dumping, and marginal ulcers were not seen. Conclusions: The longitudinal gastrectomy with duodenal switch is a safe and effective primary procedure for the treatment of morbid obesity. It has the advantage of allowing acceptable alimentation with a minimum of side effects while producing and maintaining significant weight loss. These results are achieved without developing significant dietary restrictions or clinical metabolic or nutritional complications.",
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AU - Anthone, Gary J.

AU - Lord, Reginald V N

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AU - Sarr, Michael G.

AU - Pellegrini, Carlos A.

AU - Fitzgibbons, Robert J.

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N2 - Obj ective: To determine the safety and efficacy of the duodenal switch procedure as surgical treatment of morbid obesity. Summary Background Data: The longitudinal gastrectomy and duodenal switch procedure as performed for morbid obesity involves a 75% subtotal greater curvature gastrectomy and long limb suprapapillary Roux-en-Y duodenoenterostomy. This results in a restricted caloric intake and diversion of bile and pancreatic secretions to induce fat malabsorption. Broad acceptance of this procedure has been impeded because of concerns that the malabsorptive component may produce serious nutritional complications. Methods: Review of data collected prospectively from all patients who underwent duodenal switch as the primary surgical treatment of morbid obesity at a single institution during the 10-year period beginning September 1992. Operative morbidity and mortality, weight loss, volume of food intake, and bowel function were recorded. Sequential measurements of serum albumin, hemoglobin, and calcium levels were obtained to assess metabolic function and nutrient absorption. Results: Duodenal switch was performed as the primary operation in 701 (81%) of a total 863 patients undergoing bariatric surgery during the period of study. The average body mass index (BMI) was 52.8 (range, 34-95). Perioperative mortality was 1.4%, and morbidity (including leaks, wound dehiscence, splenectomy, and postoperative hemorrhage) occurred in 21 patients (2.9%). Weight loss averaged 127 pounds at 1 year, 131 at 3 years, and 118 at 5 or more years (% EBWL of 69%, 73%, and 66%, respectively). The mean number of bowel movements was fewer than 3 per day. Patients reported and maintained a mean restriction of 63% of their preoperative intake (approximately 1600 calories), with no specific food intolerance, at 3 or more years follow-up. At 3 years, serum albumin remained at normal levels in 98% of patients, hemoglobin in 52%, and calcium in 71%. No patients reported dumping, and marginal ulcers were not seen. Conclusions: The longitudinal gastrectomy with duodenal switch is a safe and effective primary procedure for the treatment of morbid obesity. It has the advantage of allowing acceptable alimentation with a minimum of side effects while producing and maintaining significant weight loss. These results are achieved without developing significant dietary restrictions or clinical metabolic or nutritional complications.

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