Single Versus Double-Anastomosis Duodenal Switch: Single-Site Comparative Cohort Study in 440 Consecutive Patients

Abstract

Purpose: To study weight loss, comorbidity remission, complications, and nutritional deficits after duodenal switch (DS) and single-anastomosis DS with sleeve gastrectomy (SADI-S).

Material and methods: Retrospective review of patients submitted to DS or SADI-S for morbid obesity in a single university hospital.

Results: Four hundred forty patients underwent DS (n = 259) or SADI-S (n = 181). Mean preoperative body mass index (BMI) was 50.8 ± 6.4Kg/m². Mean follow-up was 56.1 ± 37.2 months for DS and 27.2 ± 18.9 months for SADI-S. Global mean excess weight loss was 77.4% at 2 years similar for SADI-S and DS, and 72.1% at 10 years after DS. Although early complications were similar in SADI-S and DS (13.3% vs. 18.9%, p = n.s.), long-term complications and vitamin and micronutrient deficiencies were superior after DS. Rate of comorbidities remission was 85.2% for diabetes, 63.9% for hypertension, 77.6% for dyslipidemia, and 82.1% for sleep apnea, with no differences between both techniques. In patients with initial BMI > 55 kg/m² (n = 91), DS achieved higher percentage of BMI < 35 kg/m² (80% vs. 50%, p = 0.025) and higher rate of diabetes remission (100% vs. 75%, p = 0050).

Conclusions: DS and SADI-S showed similar weight loss and comorbidity remission rates at 2 years. In patients with initial BMI > 55 kg/m², DS obtained better BMI control at 2 years and better diabetes remission, but more long-term complications and supplementation needs.

Keywords: BPD/DS; Bariatric surgery; Duodenal switch; Hypoabsortive surgery; Loop duodenal switch; SADI-S; SIPS.