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Common Channel Length Is Associated With Weight Loss And Nutritional Deficiencies After Duodenal Switch
Alaa Sada*, Todd A. Kellogg, Michael L. Kendrick
General Surgery, Mayo Clinic, ROCHESTER, MN
Background: Duodenal Switch (DS) is an effective bariatric procedure, typically reserved for patients with BMI>50 due to an increased risk of nutritional deficiencies. The aim of this study is to assess the effect of the common channel length on excess weight loss% (EWL) and nutritional deficiencies.
Methods: A retrospective analysis of 188 patients who had DS from March 2004 to April 2015. EWL and nutritional outcomes were evaluated based on the length of the common channel (100 vs 150) cm at 6 months postop and then yearly for 6 years. T-test was used to compare EWL, hemoglobin, iron, ferritin, folate, vitamin B12, vitamin A, vitamin E, vitamin D, calcium, total protein, albumin and HbA1c between the two groups. Fisher’s exact test was used for categorical variables.
Results: Of the188 patients (130 females, age 46.2±11.1), the average BMI was 57.1±9.7. Common channel length was 100cm in 143 patients and 150cm in 45 patients. Mean age, weight, BMI, HbA1c, nutritional markers (hemoglobin, iron, ferritin, folate, vitamin B12, vitamin A, vitamin E, vitamin D, calcium, total protein and albumin) and gender were similar between the two groups preoperatively. EWL% was higher in the 100cm group at 6 months (47.8±12.1 compared to 41.6±14, P=0.01), one year (65.9±14 compared to 54.4±15.3, P=0.0006) and two years (72±17 vs 63±19.5, P=0.04), but wasn’t statistically significant after that. At one year, the 100 cm group had lower serum total protein (6.03±0.7 g/dl vs. 6.8±0.39 g/dl, P=0.004) but the difference wasn’t significant after that. Vitamin D was lower in the 100 cm group at 6 months (22.8±11 ng/ml vs. 32.8±12.7 ng/ml, P=0.0003) but the difference wasn’t significant after that. Levels of vitamin A, vitamin E, vitamin B12, hemoglobin, iron, ferritin, folate, calcium, albumin and HbA1c weren’t statistically significant between the two groups at any time point.
Operative revision for recalcitrant nutritional deficiencies was performed in 6 patients (4%) compared to 1 patients (2%) in the 100 cm and 150 cm groups respectively.
Conclusions: Within the first two years after DS, a 100 cm common channel may be more effective at reducing EWL but is associated with increased risk of low total protein. Levels of vitamin A, vitamin E, vitamin B12, hemoglobin, iron, ferritin, folate, calcium, albumin and HbA1c may not differ significantly between the two groups. Patient specific factors should be considered in selecting the most appropriate common channel length.
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