El cruce duodenal: una terapia efectiva en la obesidad mórbida. Estudio intermedio

[Bariatric surgery in duodenal switch procedure: weight changes and associated nutritional deficiencies]

INTRODUCTION

Bariatric surgery using the technique of duodenal switch is considered as one of the most effective treatments to lose weight and decrease comorbidity in morbidly obese patients. However, we have to be familiar with and adequately manage the various nutritional deficiencies that may occur as a consequence of its practice.

OBJECTIVES

To assess weight loss and development of nutritional deficiencies in morbidly obese patients undergoing bariatric surgery through the duodenal switch procedure.

MATERIAL AND METHODS

One hundred and twenty-eight morbidly obese patients underwent a duodenal switch procedure at Hospital General Universitario in Albacete. Weight changes and the most important nutritional deficiencies occurring after surgery were recorded.

RESULTS

Median follow-up time was 30 months (interquartile range, 18 months). Body weight markedly decreased, with mean body mass index (BMI) decreasing from a preoperative value of 52.9±7.7kg/m(2) to 30.8±5.2kg/m(2) 18 months after surgery. The percentage of excess weight lost (% EWL) was 81.4±16.4% in this period. Weight loss slowed down subsequently, reaching its lowest value 30 months after surgery (% EWL 82.1%±16.8, BMI 30.2±4.3kg/m(2)) and tended to stabilize in patients with longer follow-up times. Significant nutritional deficiencies requiring replacement therapy were detected in some micronutrients with iron (42.9%), zinc (38.3%), vitamin A (55.5%), and vitamin D (57.8%) deficiencies being most relevant.

CONCLUSIONS

Duodenal switch is a very effective surgical procedure for treating morbidly obese patients because it allows for achieving a significant and sustained weight loss.Close lifetime monitoring is required in these patients because of the high prevalence of nutritional deficiencies during follow-up.

Gastric tube volume after duodenal switch and its correlation to short-term weight loss

BACKGROUND

Bariatric operations may have a restrictive and a malabsorptive component. The restrictive component is considered key for short-term weight loss. However, there are important volume discrepancies between gastric reservoirs in different bariatric surgical techniques, which questions the real meaning of the restrictive part of the operation. We have investigated the relationship between residual gastric volume after sleeve gastrectomy in duodenal switch (DS) and weight loss over the first postoperative year.

METHODS

14 patients submitted to a modified DS and one patient submitted to a sleeve gastrectomy were studied. All patients had an abdominal CT performed between the third and the ninth postoperative month to measure residual gastric volume. Gastric tube volume was correlated to early postoperative weight loss.

RESULTS

Mean excess BMI loss was 75% at 12 months. Mean gastric tube volume was 208 cc. Gastric volume was not related to preoperative weight or BMI; instead, it was directly related to patient's height. There was no statistical relation between gastric volume and weight loss at 3, 6, 9 or 12 months after the operation.

CONCLUSION

After DS, gastric tube volume is not directly related to weight changes. Other factors could have influence on intake restriction, such as gastric tube compliance or different mechanisms of satiety induction, because no differences in weight loss were observed between narrow tubes and wider ones, despite important variations in volume.