World Journal of Laparoscopic Surgery

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VOLUME 13 , ISSUE 3 ( September-December, 2020 ) > List of Articles

RESEARCH ARTICLE

Safety and Feasibility of Laparoscopic Sleeve Gastrectomy with Loop Duodenal Switch Surgery for Obesity in Indian Patients

Amar Vennapusa, Ramakanth Bhargav Panchangam, Charita Kesara, Tejaswi Chivukula

Keywords : Bariatric surgery, Biliopancreatic diversion with duodenal switch, Diabetes, Diabetes remission, Metabolic surgery, Obesity, One anastomosis gastric bypass, Single anastomosis duodenoileal bypass with sleeve, Sleeve gastrectomy, Weight loss

Citation Information : Vennapusa A, Panchangam RB, Kesara C, Chivukula T. Safety and Feasibility of Laparoscopic Sleeve Gastrectomy with Loop Duodenal Switch Surgery for Obesity in Indian Patients. World J Lap Surg 2020; 13 (3):117-124.

DOI: 10.5005/jp-journals-10033-1423

License: CC BY-NC 4.0

Published Online: 28-12-2020

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aim: Laparoscopic sleeve gastrectomy with loop duodenal switch (SLDS) surgery is a loop modification of biliopancreatic diversion with duodenal switch (BPD-DS) aimed at reducing malabsorption without compromising on the efficacy. This study aimed to analyze the safety and feasibility of SLDS surgery in Indians suffering from obesity. Materials and methods: This was a retrospective study analyzing 169 patients who underwent SLDS surgery between November 2013 and June 2020. The cohort was divided into two subgroups based on the common channel length—2.5 and ≥3 m. Weight-loss parameters, diabetes remission, and investigations at 6 months and 1 year follow-up were analyzed in the total cohort and common channel subgroups. The percentage of total weight loss (%TWL) ≥25% was considered as a successful weight-loss outcome. HbA1C <6% without the need for antidiabetic medications was considered as complete diabetes remission. Safety was analyzed in terms of intraoperative and postoperative complications. Results: Mean preoperative body mass index was 45.39 ± 7.6 kg/m2. 48.52% of the patients were suffering from type II diabetes. Mean %TWL was 30.91 ± 4.98 and 41.86 ± 7.63% and complete diabetes remission was 81.82 and 89.06% at 6 months and 1 year follow-up, respectively. The percentage of total weight loss was inversely proportional to the common channel length. Complete diabetes remission was not significantly affected by the common channel length. Serum albumin <3 gm/dL was significantly high in patients with a common channel length of 2.5 vs ≥3 m—25 vs 4.65% at 6 months and 40 vs 7.14% at 1 year follow-up, respectively. Thirty-day mortality was zero. Conclusion: Sleeve gastrectomy with loop duodenal switch surgery appears to be effective and safe in Indian patients. Malabsorption risk is greatly reduced when the common channel length is ≥3 m. Clinical significance: Sleeve gastrectomy with loop duodenal switch surgery with the common channel length ≥3 m simplifies BPD-DS, gives excellent weight loss and diabetes remission with minimal malabsorption. Restricting the biliopancreatic limb to ≤55% prevents adverse malabsorptive consequences.


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