The duodenal switch operation for the treatment of morbid XXXX .

@entity1 @entity353 @entity28 @entity1066 @entity86 @entity460 @entity1386
OBJECTIVE: To determine the safety and efficacy of the duodenal switch procedure as surgical treatment of morbid @entity28 . SUMMARY BACKGROUND DATA: The longitudinal gastrectomy and duodenal switch procedure as performed for morbid @entity28 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 @entity1386 . 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 @entity1 who underwent duodenal switch as the primary surgical treatment of morbid @entity28 at a single institution during the 10-year period beginning September 1992. Operative morbidity and mortality, @entity353 , volume of food intake, and bowel function were recorded. Sequential measurements of serum albumin, hemoglobin, and @entity460 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 @entity1 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 @entity86 ) occurred in 21 @entity1 (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. @entity1 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 @entity1 , hemoglobin in 52%, and @entity460 in 71%. No @entity1 reported dumping, and marginal @entity1066 were not seen. CONCLUSIONS: The longitudinal gastrectomy with duodenal switch is a safe and effective primary procedure for the treatment of morbid @entity28 . It has the advantage of allowing acceptable alimentation with a minimum of side effects while producing and maintaining significant @entity353 . These results are achieved without developing significant dietary restrictions or clinical metabolic or nutritional complications.
