BACKGROUBD: Gastric restriction alone does not produce adequate weight loss in the very obese (BMI > 35). Addition of malabsorptive surgery may improve results and reduce lipid levels, but risks nutritional deficits. The duodenal switch (DS) combines advantages of both procedure types with preservation of oral intake and pyloric function. Aim: The effect of DS on weight, lipid chemistry and vitamin absorption in the morbidly obese was studied.
METHODS: Serial analysis of relevant clinical and serum parameters was undertaken for 336 patients undergoing DS for 3-36 months postoperatively.
RESULTS: Initial weight and body mass index(BMI) were 317(200-623)lbs and 51(34-88)kg/m2. Percentage excess body weight loss (EBWL) is shown in the figure. Body composition and nutritional parameters are described in the table.
CONCLUSIONS: The DS provides satisfactory and durable weight and lipid reduction without evidence of nutrient deficiency.
BMI Hgb Alb Ca++ AlkP Chol Trig Vit A Vit D
Pre-op 51 13.6 4.2 9.2 87 200 161 76 40
12 mth 32 12.4 4.0 8.9 110 125 103 52 42
36 mth 31 12.0 4.2 8.6 103 128 78 60 55
Haemoglobin g/dl, Albumin g/dl, Calcium mg/dl, Alkaline phosphatase IU/l, Cholesterol mg/dl, Triglycerides mg/dl, Vitamin A mg/dl, Vitamin D g/dl