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Laurent Biertho - One of the best experts on this subject based on the ideXlab platform.
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second stage Duodenal Switch for sleeve gastrectomy failure a matched controlled trial
Surgery for Obesity and Related Diseases, 2018Co-Authors: Laurent Biertho, Fredericsimon Hould, Stefane Lebel, Simon Marceau, Francois Julien, Christel Theriault, Leonie Bouvet, Andre TchernofAbstract:Abstract Background Sleeve gastrectomy (SG) has become the predominant bariatric surgery worldwide. However, the surgical management in case of failure is still debated. Objectives To evaluate the risks and benefits of converting SG to biliopancreatic diversion with Duodenal Switch (BPD-DS) for suboptimal outcome after SG. Setting University-affiliated tertiary care center. Methods We included all patients who underwent a laparoscopic second-stage Duodenal Switch (DS) for weight loss failure after SG and had a minimal follow-up of 2 years. Patients were matched 1:1 for age, sex, body mass index, and year of surgery with a group of patients who underwent a single-stage laparoscopic BPD-DS. Data were obtained from our prospective electronic database and are reported as the mean ± standard deviation, comparing 2- versus 1-stage BPD-DS. Results A total of 118 patients were included (59 in each group). There was no significant difference in initial body mass index (53.8 ± 9.7 versus 52.7 ± 7.8 kg/m2, P = .4), age (44.0 ± 10.2 versus 43.4 ± 9.6 yr, P = .5), and sex ratio (37 female/22 male, P > .9) between the 2 groups. Mean follow-up was 59.9 ± 27 months, with an 85% (n = 100) follow-up rate. Patients were converted to BPD-DS after a mean 24.4 ± 10.2 months. There was no short- or long-term mortality. Major 90-days complications occurred in 2%, 5%, and 5% after SG, second-stage DS and single-stage BPD-DS, respectively (P > .05). At the time of conversion, the excess weight loss for SG was 39 ± 17% and total weight loss was 20 ± 9%. After DS or single-stage BPD-DS, the excess weight loss was 74.8 ± 18% versus 87.9 ± 18% at 1 year (n = 107, P = .00021), 80.2 ± 17% versus 92.3 ± 14% at 2 years (n = 100, P = .002), and 80.2 ± 18% versus 87.2 ± 16% at 3 years (n = 70, P = .6). Total weight loss was 38.7 ± 9% versus 44.5 ± 8% at 1 year (P = .0004), 41.2 ± 9% versus 46.8 ± 7% at 2 years (P = .001), and 42.3 ± 9% versus 45.1 ± 9% at 3 years (P = .2). The incidence of type 2 diabetes and hypertension before surgery were 61% versus 54% and 58% versus 47%. Remission rate for type 2 diabetes increased from 59% to 94% after second-stage DS (P = .001), which is identical to first-stage BPD-DS (94%). Remission of hypertension increased from 42% to 77% after second-stage DS (P = .03) and was 71% after first-stage BPD-DS (P = .8). Conclusion Second-stage DS is an effective option for the management of suboptimal outcomes of SG, with an additional 41% excess weight loss and 35% remission rate for type 2 diabetes. At 3 years, the global outcomes of staged approach did not significantly differ from single-stage BPD-DS; however, longer-term outcomes are still needed.
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biliopancreatic diversion with Duodenal Switch surgical technique and perioperative care
Surgical Clinics of North America, 2016Co-Authors: Laurent Biertho, Fredericsimon Hould, Stefane Lebel, Simon Marceau, Francois Julien, Simon BironAbstract:The goal of this article is to present an overview of selection criteria, surgical technique, and perioperative outcomes of biliopancreatic diversion with Duodenal Switch. The standard follow-up requirements, including vitamin supplementation, and long-term risks associated with metabolic surgery are also discussed. Most of the data reported here are based on the authors' experience with 4000 biliopancreatic diversions with Duodenal Switch performed in their institution since 1990.
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current outcomes of laparoscopic Duodenal Switch
Annals of Surgical Innovation and Research, 2016Co-Authors: Laurent Biertho, Stefane Lebel, Simon Marceau, Odette Lescelleur, Frederic Simonhould, Simon BironAbstract:Biliopancreatic diversion with Duodenal Switch (BPD-DS) has long been considered as the bariatric procedure with the highest peri-operative and long-term complication rate. However, modern peri-operative care, including laparoscopic and staged-approach, has significantly reduced the complication rate related to this procedure. The goal of this article is to provide an overview of the current outcomes of laparoscopic BPD-DS in a high volume centre. All patients who had a laparoscopic BPD-DS with a hand-sewn anastomosis performed between 2011 and 2015 (N = 566) were reviewed. Data were obtained from our prospectively maintained electronic database and are reported as a Mean ± standard deviation. The mean age of the 566 patients was 41 ± 10 years, with 78 % women. Initial body mass index was 49 ± 6 kg/m2. There was no 90-days mortality. Hospital stay was 4.5 ± 3 days. Major 30-days complications occurred in 3.0 % (n = 17) of the patients and minor complications in 2.5 % (N = 14). Excess weight loss was 81 ± 14 % at 12 m, 88 ± 13 % at 24 m, 83 ± 14 % at 36 months. Total body weight loss (kg) was 57 ± 13 kg at 12 months, 63 ± 14 kg at 24 months and 61 ± 17 kg at 36 months. Hemoglobin A1C (HbA1C) dropped from 6.1 ± 1 % to 4.7 ± 0.5 % (p < 0.005) and the percentage of patients with an HbA1C above 6 % decreased from 38 to 1.4 % (p < 0.005). Over 21 ± 12 months follow-up, readmission was required in 3.5 % and reoperation in 0.5 % of the patients. The current short and medium-term complication rate of laparoscopic BPD-DS are similar to other mixed bariatric procedures with excellent metabolic outcomes.
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malabsorption plays a major role in the effects of the biliopancreatic diversion with Duodenal Switch on energy metabolism in rats
Surgery for Obesity and Related Diseases, 2015Co-Authors: Elenadana Baraboi, Laurent Biertho, Nina L Cluny, Marieclaude Roy, Pierre Samson, Keith A Sharkey, Denis RichardAbstract:Abstract Background The mechanisms underlying the metabolic benefits of the biliopancreatic diversion with Duodenal Switch (BPD/DS) have not been clarified. The objective of this study was to investigate the metabolic roles of sleeve gastrectomy (SG) and Duodenal Switch (DS) as main surgical components of BPD/DS. Methods BPD/DS, SG, and DS surgeries were performed on chow-fed nonobese Wistar rats. Weight and energy intake were recorded during 8 postsurgical weeks. Glucagon-like peptide 1 (GLP-1), peptide tyrosine-tyrosine (PYY), glucose-dependent insulinotropic peptide, and ghrelin were measured pre- and postprandially at weeks 3 and 8, after surgery. Body composition, muscle, liver, and adipose tissue weights were measured. Gut morphometry and the presence and distribution of GLP-1 and PYY (L-cells) in the gut were determined using histochemical techniques. Results Compared with sham, BPD/DS and DS led to significant reductions in weight gain, percentage of fat, and adipose tissue weight. These effects were accompanied by a reduction in digestible energy intake associated with fecal energy loss due to DS. BPD/DS and DS produced intestinal hypertrophy, as well as higher plasma GLP-1 and PYY in both fasted and refed states. It is noteworthy that none of those alterations were observed after SG, which nonetheless led to transient postoperative reduction in gross energy intake and weight. Similar to BPD/DS, SG alone produced a reduced meal size and an enhanced postprandial depression of plasma ghrelin. Conclusion BPD/DS results in metabolic benefits, which appear largely caused by food malabsorption due to DS. The elevation of anorectic GLP-1 and PYY are additional consequences of DS, which, together with malabsorption, could promote the metabolic benefits of BPD/DS.
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biliopancreatic diversion with Duodenal Switch improves insulin sensitivity and secretion through caloric restriction
Obesity, 2014Co-Authors: Simon Marceau, Simon Biron, Laurent Biertho, Charlesetienne Plourde, Thomas Grenierlarouche, Dominique Carondorval, Stefan Lebel, Andre TchernofAbstract:Objective To assess the rapid improvement of insulin sensitivity and β-cell function following biliopancreatic diversion with Duodenal Switch (BPD-DS) and determine the role played by caloric restriction in these changes. Methods Standard meals were administrated before and on day 3, 4, and 5 after BPD-DS to measure total caloric intake, glucose excursion, insulin sensitivity, and secretion in matched type 2 diabetes and normoglycemic (NG) subjects. In a second set of study, other subjects with type 2 diabetes had the same meal tests prior to and after a 3-day caloric restriction identical to that observed after BPD-DS and then 3 days after actually undergoing BPD-DS. Results Improvement of HOMA-IR occurred at day 3 after BPD-DS in diabetes and after 3 days of caloric restriction. The disposition index (DI) improved rapidly in diabetes after BPD-DS and to a similar extent after caloric restriction. DI was higher and did not change after BPD-DS in NG. Changes in glucagon-like peptide-1, gastric inhibitory peptide, peptide tyrosine tyrosine, ghrelin, and pancreatic polypeptide levels were not associated with modulation of DI in the participants. Conclusions Caloric restriction is the major mechanism underlying the early improvement of insulin sensitivity and β-cell function after BPD-DS in type 2 diabetes.
Simon Biron - One of the best experts on this subject based on the ideXlab platform.
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biliopancreatic diversion with Duodenal Switch surgical technique and perioperative care
Surgical Clinics of North America, 2016Co-Authors: Laurent Biertho, Fredericsimon Hould, Stefane Lebel, Simon Marceau, Francois Julien, Simon BironAbstract:The goal of this article is to present an overview of selection criteria, surgical technique, and perioperative outcomes of biliopancreatic diversion with Duodenal Switch. The standard follow-up requirements, including vitamin supplementation, and long-term risks associated with metabolic surgery are also discussed. Most of the data reported here are based on the authors' experience with 4000 biliopancreatic diversions with Duodenal Switch performed in their institution since 1990.
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current outcomes of laparoscopic Duodenal Switch
Annals of Surgical Innovation and Research, 2016Co-Authors: Laurent Biertho, Stefane Lebel, Simon Marceau, Odette Lescelleur, Frederic Simonhould, Simon BironAbstract:Biliopancreatic diversion with Duodenal Switch (BPD-DS) has long been considered as the bariatric procedure with the highest peri-operative and long-term complication rate. However, modern peri-operative care, including laparoscopic and staged-approach, has significantly reduced the complication rate related to this procedure. The goal of this article is to provide an overview of the current outcomes of laparoscopic BPD-DS in a high volume centre. All patients who had a laparoscopic BPD-DS with a hand-sewn anastomosis performed between 2011 and 2015 (N = 566) were reviewed. Data were obtained from our prospectively maintained electronic database and are reported as a Mean ± standard deviation. The mean age of the 566 patients was 41 ± 10 years, with 78 % women. Initial body mass index was 49 ± 6 kg/m2. There was no 90-days mortality. Hospital stay was 4.5 ± 3 days. Major 30-days complications occurred in 3.0 % (n = 17) of the patients and minor complications in 2.5 % (N = 14). Excess weight loss was 81 ± 14 % at 12 m, 88 ± 13 % at 24 m, 83 ± 14 % at 36 months. Total body weight loss (kg) was 57 ± 13 kg at 12 months, 63 ± 14 kg at 24 months and 61 ± 17 kg at 36 months. Hemoglobin A1C (HbA1C) dropped from 6.1 ± 1 % to 4.7 ± 0.5 % (p < 0.005) and the percentage of patients with an HbA1C above 6 % decreased from 38 to 1.4 % (p < 0.005). Over 21 ± 12 months follow-up, readmission was required in 3.5 % and reoperation in 0.5 % of the patients. The current short and medium-term complication rate of laparoscopic BPD-DS are similar to other mixed bariatric procedures with excellent metabolic outcomes.
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biliopancreatic diversion with Duodenal Switch improves insulin sensitivity and secretion through caloric restriction
Obesity, 2014Co-Authors: Simon Marceau, Simon Biron, Laurent Biertho, Charlesetienne Plourde, Thomas Grenierlarouche, Dominique Carondorval, Stefan Lebel, Andre TchernofAbstract:Objective To assess the rapid improvement of insulin sensitivity and β-cell function following biliopancreatic diversion with Duodenal Switch (BPD-DS) and determine the role played by caloric restriction in these changes. Methods Standard meals were administrated before and on day 3, 4, and 5 after BPD-DS to measure total caloric intake, glucose excursion, insulin sensitivity, and secretion in matched type 2 diabetes and normoglycemic (NG) subjects. In a second set of study, other subjects with type 2 diabetes had the same meal tests prior to and after a 3-day caloric restriction identical to that observed after BPD-DS and then 3 days after actually undergoing BPD-DS. Results Improvement of HOMA-IR occurred at day 3 after BPD-DS in diabetes and after 3 days of caloric restriction. The disposition index (DI) improved rapidly in diabetes after BPD-DS and to a similar extent after caloric restriction. DI was higher and did not change after BPD-DS in NG. Changes in glucagon-like peptide-1, gastric inhibitory peptide, peptide tyrosine tyrosine, ghrelin, and pancreatic polypeptide levels were not associated with modulation of DI in the participants. Conclusions Caloric restriction is the major mechanism underlying the early improvement of insulin sensitivity and β-cell function after BPD-DS in type 2 diabetes.
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biliopancreatic diversion Duodenal Switch independent contributions of sleeve resection and Duodenal exclusion
Obesity Surgery, 2014Co-Authors: Picard Marceau, Fredericsimon Hould, Stefane Lebel, Simon Marceau, Odette Lescelleur, Simon Biron, Laurent Biertho, John G KralAbstract:The choice of first-stage operation in bilio-pancreatic diversion with Duodenal Switch (BPD-DS) is controversial. There are no published long-term comparisons of one- and two-stage BPD-DS outcomes. During 2001–2009, among 1,762 patients scheduled for BPD-DS 48 had Duodenal Switch (DS) and 53 sleeve gastrectomy (SG) as first-stage procedures. We compared prospectively updated outcomes of 42 DS (100 % open) and 49 SG (88 % laparoscopic), 13 of whom completed their second stage, to a control group of 91 patients with open one-stage BPD-DS. One-year mean percent excess weight loss (%EWL) was greater after SG than DS (47 ± 19 vs. 39 ± 13 SD; p = 0.01) with earlier nadir (16 ± 10 vs. 45 ± 30 months; p < 0.0001) but more rapid significant weight regain. After 5 years, %EWL was 12 ± 35 for 9 SG, 45 ± 19 for 30 DS (p < 0.0006), and 70 ± 18 for the first-stage BPD-DS (p < 0.0001). Weight loss was less after two- than one-stage procedures (p < 0.02). Comorbidities improved progressively between SG, DS and BPD-DS (p < 0.001 for trend). HbA1C decreased by 10, 19, and 31 %, respectively (p < 0.0001). Dyslipidemia was cured in 41, 82, and 100 %, respectively. Systolic and diastolic blood pressure decreased only after DS (12 %; p < 0.0002). Patient satisfaction was similar for SG and DS but greater after BPD-DS overall (p = 0.04). SG and DS independently contribute to beneficial metabolic outcomes after BPD-DS. Long-term weight loss and correction of metabolic abnormalities were better after DS favoring its use as first stage in BPD-DS; one-stage BPD-DS outcomes were superior to two-staged.
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is biliopancreatic diversion with Duodenal Switch indicated for patients with body mass index 50 kg m2
Surgery for Obesity and Related Diseases, 2010Co-Authors: Laurent Biertho, Fredericsimon Hould, Stefane Lebel, Simon Marceau, Simon Biron, Picard MarceauAbstract:Abstract Background Biliopancreatic diversion with Duodenal Switch (DS) has been the standard surgical approach for the treatment of morbidly obese patients at our institution since the early 1990s. The published data, however, have shown the use of the DS to be limited to the treatment of super-morbidly obese patients (body mass index [BMI] ≥50 kg/m 2 ). The aim of the present study was to present our long-term results with the DS in patients with an initial BMI of 2 . Methods This was a retrospective study of all patients with a BMI 2 who had undergone DS from June 1992 to May 2005. The data are reported as the mean ± standard deviation. Results The data from 810 consecutive patients, with a mean initial BMI of 44.2 ± 3.6 kg/m 2 , were reviewed. The mean follow-up was 103 ± 49 months. Major perioperative complications occurred in 5.8% of patients, including 5 deaths (.6%). The initial excess weight loss was 76% ± 22%, and the excess weight loss was >50% in 89% of patients. Malnutrition required readmission in 4.3% and surgical revision in 1.5%. The prevalence of severe albumin deficiency ( Conclusion These results showed that in non super-obese patients, DS was very efficient in terms of weight loss and patient satisfaction. This was associated with a 1.5% risk of revision for malnutrition. However, nutritional deficiencies required frequent readjustment of supplements, particularly for calcium, vitamin A, and vitamin D.
Michel Gagner - One of the best experts on this subject based on the ideXlab platform.
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Duodenal Switch in revisional bariatric surgery conclusions from an expert consensus panel
Surgery for Obesity and Related Diseases, 2019Co-Authors: Alexa Merz, Michel Gagner, Jacques Himpens, Antoni Torres, Kelvin Higa, Robin Blackstone, Raul J Rosenthal, Aaron Lloyd, Eric J DemariaAbstract:Abstract Background Duodenal Switch (BPD/DS) is gaining popularity as a secondary procedure for inadequate weight loss after an initial operation. Objectives We aimed to generate expert consensus points on the appropriate use of BPD/DS in the revisional bariatric surgical setting. Setting Data were gathered at an international conference with attendees from a variety of different institutions and settings. Methods Sixteen lines of questioning regarding revisional BPD/DS were presented to an expert panel of 29 bariatric surgeons. Current available literature was reviewed extensively for each topic and proposed to the panel before polling. Responses were collected and topics defined as achieving consensus (≥70% agreement) or no consensus ( Results Consensus was present in 10 of 16 lines of questioning, with several key points most prominent. Conclusions As a second-stage procedure, BPD/DS is most appropriate after sleeve gastrectomy (SG) for the treatment of super morbid obesity (96.7% agree) or as a subsequent operation for a reliable patient with insufficient weight loss after SG (88.5%). In a patient with weight regain and reflux and/or enlarged fundus after SG, Roux-en-Y gastric bypass is preferable and BPD/DS should be avoided (90%). BPD/DS should not be used prophylactically in patients with a history of jejunoileal bypass who are otherwise doing well (80.8%). Applicability of BPD/DS is limited by technical difficulty; 86.2% of experts would routinely recommend or consider the procedure if it were more technically feasible after failed bypass. No consensus was found on approaches to revision of BPD/DS for protein malnutrition.
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the impact of biliopancreatic diversion with Duodenal Switch bpd ds over 9 years
Obesity Surgery, 2017Co-Authors: Gladys W Strain, Michel Gagner, Mehyar Hefazi Torghabeh, Faith Ebel, Gregory Dakin, Daniel Connolly, Jonathan S Abelson, Alfons PompAbstract:There is limited information on the multiple long-term effects of the biliopancreatic diversion with Duodenal Switch (BPD/DS). Patients who consented to a BPD/DS from 1999 to 2010 were evaluated for weight change, complications, comorbidity resolution, body composition, quality of life, and depressive symptoms during visits at 1, 3,5, 7, and 9 years. Descriptive statistics, analysis of variance, and pair-wise comparisons were calculated for each of the five follow-up cohorts vs. the baseline cohort. Between 1999 and 2010, 284 patients received a BPD/DS; 275 patients (69.8 % women) age 42.7 years, BMI 53.4 kg/m2 qualified for baseline analysis. Two hundred seventy-five patients were available in year 1; 275 patients in year 3; 273 patients in year 5; 259 patients in year 7; and 228 patients in year 9. Gender distribution was not different. BMI was 30.1 at 1 year and 32.0 at 9 years. Body fat was reduced to 26 % after 2 years. Complications requiring surgery were significant. Nutritional problems developed in 29.8 % of patients over the course of observation. The baseline Beck Depression Index (BDI) was 13.9 and 7.2 in year 1. Year 1 through 9 remained unchanged. There were significant positive changes in quality of life between baseline and year 1 for most domains. These positive changes were maintained for the follow-up cohorts. After surgery the resolution of comorbidities continued for the 9 years. Weight loss during the first year was well maintained, resolving comorbidities and improving quality of life. Rates of surgical complications resemble other bariatric procedures. Long-term nutrient deficiencies are of concern.
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nutrient status 9 years after biliopancreatic diversion with Duodenal Switch bpd ds an observational study
Obesity Surgery, 2017Co-Authors: Gladys W Strain, Michel Gagner, Mehyar Hefazi Torghabeh, Faith Ebel, Gregory Dakin, Daniel Connolly, Elizabeth Goldenberg, Alfons PompAbstract:Background Since biliopancreatic diversion with Duodenal Switch (BPD/DS) produces hypoabsorption, evaluation of long-term nutrient changes is appropriate.
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the rationale for a Duodenal Switch as the primary surgical treatment of advanced type 2 diabetes mellitus and metabolic disease
Surgery for Obesity and Related Diseases, 2015Co-Authors: Mitchell Roslin, Michel Gagner, Richie Goriparthi, Brian MitzmanAbstract:Controversies in bariatric surgery The rationale for a Duodenal Switch as the primary surgical treatment of advanced type 2 diabetes mellitus and metabolic disease Mitchell S. Roslin, M.D., FACS*, Michel Gagner, M.D., FACS, Richie Goriparthi, M.D., M.Sc., Brian Mitzman, M.D. Department of Surgery, Lenox Hill Hospital, New York, New York Herbert Wertheim College of Medicine, Florida International University, Miami, Florida Department of Surgery, Hopital du Sacre Coeur, Montreal, QC, Canada Received November 18, 2014; accepted November 20, 2014
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laparoscopic hiatal hernia repair and repeat sleeve gastrectomy for gastroesophageal reflux disease after Duodenal Switch
Surgery for Obesity and Related Diseases, 2008Co-Authors: Manish Parikh, Michel GagnerAbstract:Hiatal hernia is frequently seen in the bariatric population. It is often associated with severe reflux that can lead to a decreased quality of life and poor weight loss or even weight regain after bariatric surgery. We present a patient who complained of severe reflux and weight regain 5 years after laparoscopic biliopancreatic diversion with a Duodenal Switch (BPD-DS). The associated video demonstrates the laparoscopic repair of the patient’s hiatal hernia (including reduction of the incarcerated sleeve and crural repair) and “re-sleeve” gastrectomy. Case report The patient was a 49-year-old woman who had undergone laparoscopic BPD-DS 5 years before for a body mass index (BMI) of 55 kg/m 2 . At that time, the sleeve gastrectomy was performed over a 60F Bougie, and the Duodenal Switch consisted of a 150-cm alimentary limb and 100-cm common channel. She had no medical problems, and her surgical history was relevant for open cholecystectomy before her BPD-DS. Her lowest BMI postoperatively was 28 kg/m 2 . She had recently complained of epigastric pain, severe reflux, and weight regain (BMI 31 kg/m 2 ). An upper
Daniel Cottam - One of the best experts on this subject based on the ideXlab platform.
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single anastomosis Duodenal Switch 1 year outcomes
Obesity Surgery, 2020Co-Authors: Daniel Cottam, Dana Portenier, Mitchell Roslin, Paul Enochs, Matthew Metz, Dennis SmithAbstract:Single-anastomosis Duodenal Switch has been suggested to be an effective bariatric procedure that offers excellent weight loss and by lengthening the common channel the potential to reduce micronutrient deficiencies. To evaluate the weight loss, comorbidity resolution and the 1-year nutritional outcomes of the single-anastomosis Duodenal Switch (SADS) procedure. Multiple US Hospitals. From October 2014 to January 2017, 120 patients were enrolled at six sites across the USA and underwent the SADS procedure. Weight loss, comorbidities, quality of life, and adverse events were followed post-procedure for 12 months. At 1, 6, and 12 months, 98.3%, 85.5%, and 77.1% of the patients were available for assessment, respectively. At 12 months, patients showed significantly reduced body mass index when compared to baseline (46.8 ± 5.8 vs 29.8 ± 4.4, P < 0.001 respectively). Sixty-five patients had type 2 diabetes at baseline; however, 11 patients lost to follow-up. Of the available data (54 patients), 96.3% of the patients had a resolution of type 2 diabetes by 12 months with a mean A1C reduction from 7.8 ± 1.6 to 5.3 ± 0.7. Additionally, there were reductions in hyperlipidemia, sleep apnea, and hypertension at 12 months. Patient gastroesophageal reflux disease satisfaction and quality of life (SF-36) scores were significantly higher at 12 months post-procedure (P < 0.001 in all cases) while 12-month protein levels remained at normal values. There were abnormalities of parathyroid hormone and vitamin D at 1 year with all other nutritional markers being not significantly different at 1 year from baseline. There were 10, IIIb, or greater complications according to the Clavien-Dindo scoring system during the study period, not all of which were related to the surgery. SADS is a highly efficacious weight loss procedure with significant comorbidity reduction at 1 year. At 1 year, complications and vitamin and mineral deficits appear to be consistent with other malabsorption operations. Long-term follow-up is needed, especially around complications and vitamin deficiencies.
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the incidence of complications associated with loop duodeno ileostomy after single anastomosis Duodenal Switch procedures among 1328 patients a multicenter experience
Surgery for Obesity and Related Diseases, 2018Co-Authors: Amit Surve, Daniel Cottam, Andres Sanchezpernaute, Antoni Torres, Joshua E Roller, Yong Kwon, Joshua Mourot, Bleu Schniederjan, Bo Neichoy, Paul EnochsAbstract:Abstract 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/m 2 . 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 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.
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a retrospective comparison of biliopancreatic diversion with Duodenal Switch with single anastomosis Duodenal Switch sips stomach intestinal pylorus sparing surgery at a single institution with two year follow up
Surgery for Obesity and Related Diseases, 2017Co-Authors: Amit Surve, Daniel Cottam, Austin Cottam, Hinali Zaveri, Legrand Belnap, Samuel CottamAbstract:Abstract Background The traditional Duodenal Switch is performed using a Roux-en-Y configuration. This procedure has proven to be the most effective procedure for long-term weight loss and co-morbidity reduction. Recently, stomach intestinal pylorus sparing surgery (SIPS) has been introduced as a simpler and potentially safer variation of the Duodenal Switch (DS). It is a single anastomosis end-to-side proximal duodeno-ileal bypass with a sleeve gastrectomy. In this study, we compare our outcomes between biliopancreatic diversion with Duodenal Switch (BPD-DS) and SIPS at 2 years. Setting This is a retrospective analysis from a single surgeon at a single private institution. Methods We analyzed data from 182 patients retrospectively, 62 patients underwent BPD-DS while 120 other patients underwent SIPS between September 2011 and March 2015. A subset analysis was performed comparing data from both procedures to evaluate weight loss and complications. Results Of 182 patients, 156 patients were beyond 1 year postoperative mark and 99 patients were beyond 2 year postoperative mark. Five patients were lost to follow-up. None of our patients had complications resulting in death. BPD-DS and SIPS had statistically similar weight loss at 3 months but percent excess weight loss (%EWL) was more with BPD-DS than SIPS at 6, 9, 12, 18, and 24 months. Patient lost a mean body mass index (BMI) of 23.3 (follow-up: 69%) and 20.3 kg/m 2 (follow-up: 71%) at 2 years from the BPD-DS and SIPS surgery, respectively. However, patients who had undergone SIPS procedure had significantly shorter operative time, shorter length of stay, fewer perioperative and postoperative complications than BPD-DS ( P P Conclusion The SIPS is a simplified DS procedure. The SIPS eliminates one anastomosis and compared with BPD-DS has fewer perioperative and postoperative complications, shorter operative time and length of stay, and similar nutritional results at 2 years. However, weight loss was more with BPD-DS. A fair criticism is that the vast majority of BPD-DS cases were done before the SIPS cases. As a result, experience and learning curve cannot be completely dismissed when viewing postoperative complications.
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a matched cohort analysis of stomach intestinal pylorus saving sips surgery versus biliopancreatic diversion with Duodenal Switch with two year follow up
Obesity Surgery, 2017Co-Authors: Austin Cottam, Daniel Cottam, Dana Portenier, Hinali Zaveri, Amit Surve, Samuel Cottam, Legrand Belnap, Walter Medlin, Christina RichardsAbstract:Background In bariatric surgery, the procedure with the highest average weight loss is the biliopancreatic diversion with Duodenal Switch (BPDDS). A new simplified Duodenal Switch called the stomach intestinal pylorus sparing (SIPS) surgery with less malabsorption and one fewer anastomosis claims to have similar outcomes when compared to the BPDDS.
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a matched cohort analysis of stomach intestinal pylorus saving sips surgery versus biliopancreatic diversion with Duodenal Switch with two year follow up
Obesity Surgery, 2017Co-Authors: Austin Cottam, Daniel Cottam, Dana Portenier, Hinali Zaveri, Amit Surve, Samuel Cottam, Legrand Belnap, Walter Medlin, Christina RichardsAbstract:In bariatric surgery, the procedure with the highest average weight loss is the biliopancreatic diversion with Duodenal Switch (BPDDS). A new simplified Duodenal Switch called the stomach intestinal pylorus sparing (SIPS) surgery with less malabsorption and one fewer anastomosis claims to have similar outcomes when compared to the BPDDS. A retrospective matched cohort analysis of SIPS versus BPDDS patients in a single private practice was obtained by matching every BPDDS to a SIPS patient of the same gender and BMI. Excess weight loss percentage (EWL), BMI, and percentage total weight loss (%TWL) were compared. Additionally, comorbidity resolution, nutritional data, and complications were also compared. Data was analyzed using both descriptive and comparative statistics. Over 2 years, there was no statistical difference in weight loss between BPDDS and SIPS. There also was no difference in nutritional data between the two procedures pre- and post-op. Complication rates were lower in SIPS however, due to the small sample sizes this is not statistically significant. Weight loss and nutritional results between SIPS and BPDDS are similar at 2 years. However, there are fewer complications with SIPS.
Fredericsimon Hould - One of the best experts on this subject based on the ideXlab platform.
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second stage Duodenal Switch for sleeve gastrectomy failure a matched controlled trial
Surgery for Obesity and Related Diseases, 2018Co-Authors: Laurent Biertho, Fredericsimon Hould, Stefane Lebel, Simon Marceau, Francois Julien, Christel Theriault, Leonie Bouvet, Andre TchernofAbstract:Abstract Background Sleeve gastrectomy (SG) has become the predominant bariatric surgery worldwide. However, the surgical management in case of failure is still debated. Objectives To evaluate the risks and benefits of converting SG to biliopancreatic diversion with Duodenal Switch (BPD-DS) for suboptimal outcome after SG. Setting University-affiliated tertiary care center. Methods We included all patients who underwent a laparoscopic second-stage Duodenal Switch (DS) for weight loss failure after SG and had a minimal follow-up of 2 years. Patients were matched 1:1 for age, sex, body mass index, and year of surgery with a group of patients who underwent a single-stage laparoscopic BPD-DS. Data were obtained from our prospective electronic database and are reported as the mean ± standard deviation, comparing 2- versus 1-stage BPD-DS. Results A total of 118 patients were included (59 in each group). There was no significant difference in initial body mass index (53.8 ± 9.7 versus 52.7 ± 7.8 kg/m2, P = .4), age (44.0 ± 10.2 versus 43.4 ± 9.6 yr, P = .5), and sex ratio (37 female/22 male, P > .9) between the 2 groups. Mean follow-up was 59.9 ± 27 months, with an 85% (n = 100) follow-up rate. Patients were converted to BPD-DS after a mean 24.4 ± 10.2 months. There was no short- or long-term mortality. Major 90-days complications occurred in 2%, 5%, and 5% after SG, second-stage DS and single-stage BPD-DS, respectively (P > .05). At the time of conversion, the excess weight loss for SG was 39 ± 17% and total weight loss was 20 ± 9%. After DS or single-stage BPD-DS, the excess weight loss was 74.8 ± 18% versus 87.9 ± 18% at 1 year (n = 107, P = .00021), 80.2 ± 17% versus 92.3 ± 14% at 2 years (n = 100, P = .002), and 80.2 ± 18% versus 87.2 ± 16% at 3 years (n = 70, P = .6). Total weight loss was 38.7 ± 9% versus 44.5 ± 8% at 1 year (P = .0004), 41.2 ± 9% versus 46.8 ± 7% at 2 years (P = .001), and 42.3 ± 9% versus 45.1 ± 9% at 3 years (P = .2). The incidence of type 2 diabetes and hypertension before surgery were 61% versus 54% and 58% versus 47%. Remission rate for type 2 diabetes increased from 59% to 94% after second-stage DS (P = .001), which is identical to first-stage BPD-DS (94%). Remission of hypertension increased from 42% to 77% after second-stage DS (P = .03) and was 71% after first-stage BPD-DS (P = .8). Conclusion Second-stage DS is an effective option for the management of suboptimal outcomes of SG, with an additional 41% excess weight loss and 35% remission rate for type 2 diabetes. At 3 years, the global outcomes of staged approach did not significantly differ from single-stage BPD-DS; however, longer-term outcomes are still needed.
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biliopancreatic diversion with Duodenal Switch surgical technique and perioperative care
Surgical Clinics of North America, 2016Co-Authors: Laurent Biertho, Fredericsimon Hould, Stefane Lebel, Simon Marceau, Francois Julien, Simon BironAbstract:The goal of this article is to present an overview of selection criteria, surgical technique, and perioperative outcomes of biliopancreatic diversion with Duodenal Switch. The standard follow-up requirements, including vitamin supplementation, and long-term risks associated with metabolic surgery are also discussed. Most of the data reported here are based on the authors' experience with 4000 biliopancreatic diversions with Duodenal Switch performed in their institution since 1990.
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biliopancreatic diversion Duodenal Switch independent contributions of sleeve resection and Duodenal exclusion
Obesity Surgery, 2014Co-Authors: Picard Marceau, Fredericsimon Hould, Stefane Lebel, Simon Marceau, Odette Lescelleur, Simon Biron, Laurent Biertho, John G KralAbstract:The choice of first-stage operation in bilio-pancreatic diversion with Duodenal Switch (BPD-DS) is controversial. There are no published long-term comparisons of one- and two-stage BPD-DS outcomes. During 2001–2009, among 1,762 patients scheduled for BPD-DS 48 had Duodenal Switch (DS) and 53 sleeve gastrectomy (SG) as first-stage procedures. We compared prospectively updated outcomes of 42 DS (100 % open) and 49 SG (88 % laparoscopic), 13 of whom completed their second stage, to a control group of 91 patients with open one-stage BPD-DS. One-year mean percent excess weight loss (%EWL) was greater after SG than DS (47 ± 19 vs. 39 ± 13 SD; p = 0.01) with earlier nadir (16 ± 10 vs. 45 ± 30 months; p < 0.0001) but more rapid significant weight regain. After 5 years, %EWL was 12 ± 35 for 9 SG, 45 ± 19 for 30 DS (p < 0.0006), and 70 ± 18 for the first-stage BPD-DS (p < 0.0001). Weight loss was less after two- than one-stage procedures (p < 0.02). Comorbidities improved progressively between SG, DS and BPD-DS (p < 0.001 for trend). HbA1C decreased by 10, 19, and 31 %, respectively (p < 0.0001). Dyslipidemia was cured in 41, 82, and 100 %, respectively. Systolic and diastolic blood pressure decreased only after DS (12 %; p < 0.0002). Patient satisfaction was similar for SG and DS but greater after BPD-DS overall (p = 0.04). SG and DS independently contribute to beneficial metabolic outcomes after BPD-DS. Long-term weight loss and correction of metabolic abnormalities were better after DS favoring its use as first stage in BPD-DS; one-stage BPD-DS outcomes were superior to two-staged.
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laparoscopic sleeve gastrectomy with or without Duodenal Switch a consecutive series of 800 cases
Digestive Surgery, 2014Co-Authors: Laurent Biertho, Picard Marceau, Fredericsimon Hould, S Lebel, S Marceau, O Lescelleur, S BironAbstract:Background: Sleeve gastrectomy (SG) was originally performed as the restrictive and acid-reducing part of a biliopancreatic diversion with Duodenal Switch (BPD-DS
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is biliopancreatic diversion with Duodenal Switch indicated for patients with body mass index 50 kg m2
Surgery for Obesity and Related Diseases, 2010Co-Authors: Laurent Biertho, Fredericsimon Hould, Stefane Lebel, Simon Marceau, Simon Biron, Picard MarceauAbstract:Abstract Background Biliopancreatic diversion with Duodenal Switch (DS) has been the standard surgical approach for the treatment of morbidly obese patients at our institution since the early 1990s. The published data, however, have shown the use of the DS to be limited to the treatment of super-morbidly obese patients (body mass index [BMI] ≥50 kg/m 2 ). The aim of the present study was to present our long-term results with the DS in patients with an initial BMI of 2 . Methods This was a retrospective study of all patients with a BMI 2 who had undergone DS from June 1992 to May 2005. The data are reported as the mean ± standard deviation. Results The data from 810 consecutive patients, with a mean initial BMI of 44.2 ± 3.6 kg/m 2 , were reviewed. The mean follow-up was 103 ± 49 months. Major perioperative complications occurred in 5.8% of patients, including 5 deaths (.6%). The initial excess weight loss was 76% ± 22%, and the excess weight loss was >50% in 89% of patients. Malnutrition required readmission in 4.3% and surgical revision in 1.5%. The prevalence of severe albumin deficiency ( Conclusion These results showed that in non super-obese patients, DS was very efficient in terms of weight loss and patient satisfaction. This was associated with a 1.5% risk of revision for malnutrition. However, nutritional deficiencies required frequent readjustment of supplements, particularly for calcium, vitamin A, and vitamin D.
