Abstracts
2000 Digestive Disease Week

# 2325 Results of the Duodenal Switch for the Surgical Treatment of Morbid Obesity.
Gary J. Anthone, Los Angeles, CA

Introduction: The duodenal switch, a form of the biliopancreatic diversion procedure, was first performed to reduce the side effects seen with other obesity operations. The duodenal switch maintains the pylorus and first portion of the duodenum in the alimentary stream, reducing the incidence of dumping symptoms and marginal ulceration. A 75% greater curvature gastrectomy and long limb Roux-en Y duodeno-ileostomy are performed to restrict caloric intake and divert bile from the alimentary contents. We present our initial results with this procedures: Methods: A restrospective review of patient records who underwent the duodenal switch as primary surgical treatment for morbid obesity at USC from 1993 to 1999. All patients underwent extensive preoperative evaluation. Postoperatively, patients were instructed to take oral vitamin and mineral supplements. Results: A total of 321 patients underwent bariatric surgery. 226 patients had the duodenal switch as their primary procedure. Perioperative mortality was less than 1%. Perioperative morbidity consisted of wound infections (9%) and nausea/vomiting (36%), which essentially disappeared after 3-6 months at which time patients reported no specific dietary restrictions. 36% of patients developed incisional hernias. There were no marginal ulcers and no complaints of dumping symptoms. Greater than 90% of patients had complete resolution or significant improvement of their co-morbid related conditions (i.e., hypertension, insulin resistant diabetes, Pickwickian syndrome). Conclusion: The duodenal switch is a safe and effective procedure for the treatment of morbid obesity and its related co-morbid conditions. It has the advantage of decreasing the side effects seen with other currently performed procedures. The duodenal switch should be considered as a viable treatment option for this disease process.