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Outcome of duodenal switch with a transitory vertical gastroplasty, in super-super-obese patients in an 8-year series.

Di Betta E, Mittempergher F, Nascimbeni R, Salerni B

Cattedra di Chirurgia Generale, Università degli Studi di Brescia, U.O. 1 Chirurgia Generale, Ple Spedali Civili 2, 25133, Brescia, Italy, edibetta@libero.it.

BACKGROUND: In super-super obese (SSO) patients [body mass index (BMI) superior of 60 kg/m(2)] results of bariatric surgery are still controversial. This study evaluated safety and efficacy of open duodenal switch associated with transitory vertical gastroplasty (DS-TVG) after 8 years of follow-up. METHODS: A prospective observational study of 32 SSO patients who underwent an open DS-TVG from January 1999 till March 2006 was performed. Study endpoints included preoperative comorbidities [diabetes, hypertension, and obstructive sleep apnea syndrome (OSAS)], postoperative morbidity and mortality, and long-term results of BMI and percent of excess weight loss (%EWL) (median 48 months). RESULTS: Results in terms of BMI and %EWL were, respectively, after 12 months, 46.3 +/- 10.2 and 57.1 +/- 9.8; after 36 months (n = 21), 37.5 +/- 7.5 and 73.5 +/- 6.2; and after 84 months (n = 5), 31.7 +/- 2.8 and 76.0 +/- 4.1. With regard to comorbidities, we observed complete control of lipid alterations and type-2 diabetes (suspension therapy within 1 year). All patients with OSAS improved within 1 year without needing domiciliary oxygen therapy. Neither malnutrition nor mortality was observed during the follow-up. Major complications occurred in a total of 5 patients (15.6%): pulmonary embolism (2 cases-9.4%); gastrointestinal bleeding, requiring transfusions (1 case-3.1%); 1 case (3.1%) of abdominal rupture; and 1 case of acute pancreatitis (3.1%). Minor complications occurred in 4 patients (12.5%): 1 case of pneumonia, 1 urinary tract infection, and 2 wound infections. CONCLUSION: Although this study evaluated the outcomes of a small series of patients after open DS-TVG, this procedure seems to be safe and effective in obese patients who have a BMI greater than 60 kg/m(2). In our opinion, DS-TVG should be considered as a valid surgical option with two staged laparoscopic procedures.

Published 6 February 2008 in Obes Surg, 18(2): 182-6.
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