According to results from a matched cohort study, weight loss is better with Roux duodenal switch compared with single anastomosis duodeno-ileostomy with sleeve gastrectomy (SADI-S), but this weight loss does not translate into better resolution of comorbidities. These findings were presented at the 2021 annual meeting of the American Society for Metabolic and Bariatric Surgery (abstract A001).
According to presenting study author Daniel Cottam, MD, a general surgeon at the Bariatric Medicine Institute, in Salt Lake City, prior to this study, it was unknown whether the long-term outcomes of Roux DS are superior, similar or inferior to those of SADI-S when controlling for similar total bowel lengths. In the new study, researchers at the Bariatric Medicine Institute compared Roux-en-Y duodenal switch patients with a 150-cm Roux limb and 150-cm common channel with SADI-S patients with a 300-cm common channel. The total alimentary limb lengths in both groups were 300 cm.
Data were used for a retrospective matched cohort from 815 patients who underwent a primary laparoscopic traditional DS or primary laparoscopic SADI-S from September 2011 through November 2019 by four surgeons. Data were obtained by matching DS patients to SADI-S patients of the same age, sex and body mass index. In addition, only patients who were out at least five years and had a minimum five-year follow-up were included in the study. There were 30 patients in each group.
The researchers found that the total number of patients who experienced long-term complications was significantly higher in the DS group (18 vs. six; P=0.004). There was no statistically significant difference in the short-term (<30 days) complication rate. Of all Clavien-Dindo classification grades, only grade 3b complications were significantly higher in the DS group (P=0.003).
The total number of patients who required long-term reintervention was significantly higher in the DS group (18 vs. nine; P=0.019). The total number of patients who required CT was significantly higher in the DS group (eight vs. one; P=0.026). At five and six years, the weight loss was significantly better with DS, but the ending BMI points at five and six years were statistically similar between the two groups. The long-term weight loss failure rate was statistically similar between both groups. The long-term resolution rates of type 2 diabetes, hypertension, obstructive sleep apnea and gastroesophageal reflux disease were statistically similar between both groups. There also was no statistically significant difference in nutritional data between the two procedures before and after surgery, but follow-up numbers were low.
According to Dr. Cottam, the nutritional and complication data with a small cohort should be viewed skeptically. Dr. Cottam said the Roux DS procedure with 150 Roux/150 common channel seems to offer somewhat better weight loss at six years than the SADI-S procedure, but the real long-term difference between the two groups was approximately 15 to 20 pounds without an impact on the comorbidity resolution.
Dr. Cottam is part of the speakers bureau for Medtronic, and has been awarded a research grant by Medtronic for the study of duodenal switch. He also has received personal fees from GI Windows.
This article is from the July 2021 print issue.
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