Page 18 - World Journal of Laparoscopic Surgery

RESEARCH ARTICLE
Safety and Feasibility of Laparoscopic Sleeve Gastrectomy

with Loop Duodenal Switch Surgery for Obesity in Indian

Patients

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Amar Vennapusa , Ramakanth Bhargav Panchangam , Charita Kesara , Tejaswi Chivukula 4
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.
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Results: Mean preoperative body mass index was 45.39 ± 7.6 kg/m . 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.
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.
World Journal of Laparoscopic Surgery (2020): 10.5005/jp-journals-10033-1423

IntroductIon 1,3,4 Department of Bariatric and Metabolic Surgery, Dr Amar Bariatric
Bariatric surgery offers durable weight loss and diabetes remission and Metabolic Center, Hyderabad, Telangana, India
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with minimal complications. Hormonal and physiological Department of Endocrine and Metabolic Surgery, Endocare Hospital,
alterations are mainly responsible for the metabolic effects after Vijayawada, Andhra Pradesh, India
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bariatric surgery. Metabolic outcomes are significantly better Corresponding Author: Amar Vennapusa, Department of Bariatric and
after laparoscopic biliopancreatic diversion with duodenal switch Metabolic Surgery, Dr Amar Bariatric and Metabolic Center, Hyderabad,
(BPD-DS) compared to standard surgeries like laparoscopic Telangana, India, Phone: +91 96766 75646, e-mail: drVamar@gmail.
Roux-en-Y gastric bypass (RYGB). But nutritional deficiencies com
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are also higher after BPD-DS. It is not widely performed How to cite this article: Vennapusa A, Panchangam RB, Kesara C, et al.
because of its technical complexity and increased risk of severe Safety and Feasibility of Laparoscopic Sleeve Gastrectomy with Loop
Duodenal Switch Surgery for Obesity in Indian Patients. World J Lap
malabsorption. Surg 2020;13(3):117–124.
Single anastomosis duodenoileal bypass with sleeve (SADI-S)
is a loop modification of duodenal switch with a 2–2.5 m common Source of support: Nil
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channel. It simplifies the procedure and reduces malabsorption to Conflict of interest: None
some extent. But even with 2.5 m common channel malabsorption
can be significant in SADI-S. Increasing common channel length to
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3 m can effectively reduce malabsorption. Several loop duodenal is common channel length can be tailored according to the
switch (LDS) surgeries were described in the literature with different individual requirement and depending on the total bowel length.
common channel lengths. 5 There is no literature available from the Indian subcontinent about
Sleeve gastrectomy with loop duodenal switch (SLDS) is a this procedure. We analyzed our experience with this surgical
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loop modification of BPD-DS (Fig. 1). It is technically simple with technique in Indian patients suffering from obesity to ascertain
only one anastomosis, compared to BPD-DS. One main advantage its safety, feasibility, and efficacy.

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