Page 20 - World Journal of Laparoscopic Surgery

Safety and Feasibility of Sleeve Gastrectomy with Loop Duodenal Switch
Patients were discharged on the second postoperative day. on %EWL was found to be insignificant (Table 1). The weight-loss
Contrast X-ray and an abdominal sonography were performed 1 success rate was 91.45% (139/152) and 99.2% (124/125) at 6 months
week and 1 month postoperatively to screen for leak and bleeding. and 1 year follow-up when %TWL ≥25% was taken as a reference
Patients were prescribed lifelong bariatric multivitamin, mineral point. These values were 97.37% (148/152) and 100% (125/125) at
supplements, and ursodeoxycholic acid for 18 months. 6 months and 1 year follow-up when %EWL ≥50% was taken as a
Weight and BMI were documented at 6 months and 1 year reference point. There was no significant difference in the weight-
follow-up and percentage of excess weight loss (%EWL) with loss success rates between the common channel subgroups.
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BMI reference point of 25 kg/m and percentage of total weight HbA1C in the total cohort and common channel subgroups at
loss (%TWL) were calculated. The percentage of total weight loss 6 months and 1 year follow-up are summarized in Table 2. HbA1C
≥25% was considered as a successful weight-loss outcome. The was significantly low at 6 months and 1 year follow-up compared to
percentage of excess weight loss ≥50% was taken as an alternative preoperative values. There was no significant difference in HbA1C
reference point to define a successful outcome. Complete diabetes between the common channel subgroups at 6 months follow-up.
remission was defined as HbA1C <6% with no antidiabetic But HbA1C was significantly low in patients with common channel
medications needed for glycemic control. Partial diabetes remission length 2.5 vs ≥3 m at 1 year follow-up.
was defined as HbA1C ≥6% but <6.5% in the absence of antidiabetic Complete diabetes remission, partial diabetes remission, and
medications. Diabetes improvement was defined as a statistically diabetes improvement with HbA1C <6% reference point in the
significant reduction in HbA1C not meeting the criteria for complete total cohort and common channel subgroups at 6 months and 1
or partial remission or decrease in requirement for antidiabetic year follow-up are summarized in Table 2. There was no significant
medications. Differences in %TWL, %EWL, and HbA1C at 6 months difference in the percentage of complete diabetes remission
and 1 year follow-up in subgroups based on the common channel between common channel subgroups. There were no symptoms
were calculated using independent samples t test. The effect of hypoglycemia or dumping syndrome in any of our patients.
of common channel length on the weight-loss parameters was Responses of different comorbid conditions to SLDS surgery are
analyzed using simple linear regression and multiple regression summarized in Table 3.
analysis. The effect of common channel length on the weight-loss Indicators of nutritional status are detailed in Table 4. Protein-
success rates and diabetes remission rates was calculated using energy malnutrition with serum albumin levels <3 gm/dL was
logistic regression analysis. IBM SPSS version 26 (IBM Corp., Armonk, significantly high in patients with a common channel length of 2.5 vs
NY, USA) was used for statistical analysis. p value of <0.05 was ≥3 m—25 vs 4.65% at 6 months and 40 vs 7.14% at 1 year follow-up,
considered significant in various statistical tests. respectively. In patients with common channel length ≥3 m, all
Major complications, such as, internal bleeding and leak, were the patients with serum albumin <3 gm/dL at 6 months and 1 year
documented. Nutritional parameters including total protein and follow-up had biliopancreatic limb length of >55%. Poor nutritional
serum albumin at 6 months and 1 year follow-up were documented. intake coupled with malabsorption was responsible for protein-
energy malnutrition in these patients. Marked hypoalbuminemia
results (<2.5 g/dL) with clinical manifestations in eight patients (5 and 3
A total of 171 patients underwent SLDS surgery between November from 2.5 m and ≥3 m common channel subgroups, respectively) was
corrected using intravenous amino acid injections, a high protein
2013 and June 2020. One hundred and sixty-nine patients who met diet, and regular exercises. Hypoalbuminemia improved in all these
the inclusion criteria were analyzed. The mean age was 40.53 ± 10.07 patients except in two of them, one from each subgroup, who lost
years (16–68). Male:female ratio was 87:82. BMI of 24.85% (42/169) life >1 year after surgery. All patients who developed mild vitamin
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patients was ≥50 kg/m . 48.52% (82/169) patients were suffering and mineral deficiencies responded well to oral supplements.
from type II diabetes. 30.18% (51/169) patients had prediabetes. The Concomitant cholecystectomy was performed in 10 patients,
average common channel length was 3.33 ± 0.41 (2.5–4.32) m. A adhesiolysis in 21, and different types of hernia repairs in 11 patients.
fixed common channel variant was performed in 144 patients (the The mean duration of surgery was 191.49 minutes. Intraoperative
common channel was fixed at 2.5, 3, and 3.5 m in 26, 16, and 102 injury to RGA with 250 mL blood loss occurred in one patient.
patients, respectively). Fixed ratio bypass variant was performed Bleeding was controlled with a vessel sealer. 1.18% (2/169) patients
in 25 patients (the common channel length was 55% in 1, 50% in developed postoperative bleeding on the first postoperative day,
13, 45% in 8, and 40% in 3 patients). 98.7% (152/154) and 91.24% requiring diagnostic laparoscopy and lavage. All these patients
(125/137) patients were available at the 6 months and 1 year recovered without any adverse postoperative events. One patient
follow-up, respectively. developed a localized leak 10 days after surgery but recovered with
Weight and BMI parameters of patients at different time conservative treatment. 28.18 and 27.08% patients complained
intervals are summarized in Table 1. Overall weight and BMI were of diarrhea, 80 and 66.67% steatorrhea, 74.55 and 65.63% foul-
significantly less at 6 months and 1 year follow-up compared to smelling gas, and 11.82 and 8.33% incontinence at 6 months
preoperative values (Table 1). The percentage of total weight loss and 1 year follow-up after surgery, respectively, when their diet
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and %EWL with BMI reference point of 25 kg/m in the total cohort contained oil, spice, or chilly. 4.55 and 3.13% of patients complained
and common channel subgroups at 6 months and 1 year follow-up of constipation at 6 months and 1 year follow-up after surgery,
after surgery are summarized in Table 1. Independent samples t test respectively. Thirty-day mortality was zero. None of the patients
showed significantly more %TWL in patients with 2.5 m common had gastroesophageal reflux, marginal ulcers, or internal herniation.
channel compared to those with ≥3 m. Simple linear regression
and multiple regression analysis showed that %TWL was inversely
proportional to the common channel length at 6 months and 1 dIscussIon
year follow-up. The percentage of excess weight loss was similar Laparoscopic SG has gained a lot of popularity and became the most
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between the subgroups and the common channel length effect commonly performed surgery worldwide. Its technical simplicity,

World Journal of Laparoscopic Surgery, Volume 13 Issue 3 (September–December 2020) 119