Surve Amit, Zaveri Hinali, Cottam Daniel, Belnap LeGrand, Cottam Austin, Cottam Samuel
Bariatric Medicine Institute, Salt Lake City, Utah.
Bariatric Medicine Institute, Salt Lake City, Utah.
Surg Obes Relat Dis. 2017 Mar;13(3):415-422. doi: 10.1016/j.soard.2016.11.020. Epub 2016 Dec 2.
The traditional duodenal switch is performed using a Roux-en-Y configuration. This procedure has proven to be the most effective procedure for long-term weight loss and co-morbidity reduction. Recently, stomach intestinal pylorus sparing surgery (SIPS) has been introduced as a simpler and potentially safer variation of the duodenal switch (DS). It is a single anastomosis end-to-side proximal duodeno-ileal bypass with a sleeve gastrectomy. In this study, we compare our outcomes between biliopancreatic diversion with duodenal switch (BPD-DS) and SIPS at 2 years.
This is a retrospective analysis from a single surgeon at a single private institution.
We analyzed data from 182 patients retrospectively, 62 patients underwent BPD-DS while 120 other patients underwent SIPS between September 2011 and March 2015. A subset analysis was performed comparing data from both procedures to evaluate weight loss and complications.
Of 182 patients, 156 patients were beyond 1 year postoperative mark and 99 patients were beyond 2 year postoperative mark. Five patients were lost to follow-up. None of our patients had complications resulting in death. BPD-DS and SIPS had statistically similar weight loss at 3 months but percent excess weight loss (%EWL) was more with BPD-DS than SIPS at 6, 9, 12, 18, and 24 months. Patient lost a mean body mass index (BMI) of 23.3 (follow-up: 69%) and 20.3 kg/m (follow-up: 71%) at 2 years from the BPD-DS and SIPS surgery, respectively. However, patients who had undergone SIPS procedure had significantly shorter operative time, shorter length of stay, fewer perioperative and postoperative complications than BPD-DS (P<.001). Interestingly, even though BPD-DS patients lost slightly more weight, the actual final BMI for SIPS group was lower than BPD-DS group (25.6 versus 26.9) (P<.05). There was no statistical difference between 2 groups for postoperative nutritional data such as vitamins D, B1, B12, serum calcium, fasting blood glucose, glycosylated hemoglobin (HbA1C), insulin, serum albumin, serum total protein, and lipid panel.
The SIPS is a simplified DS procedure. The SIPS eliminates one anastomosis and compared with BPD-DS has fewer perioperative and postoperative complications, shorter operative time and length of stay, and similar nutritional results at 2 years. However, weight loss was more with BPD-DS. A fair criticism is that the vast majority of BPD-DS cases were done before the SIPS cases. As a result, experience and learning curve cannot be completely dismissed when viewing postoperative complications.
传统十二指肠转位术采用Roux-en-Y构型。该手术已被证明是长期减重及降低合并症最有效的手术。最近，保留胃十二指肠幽门手术（SIPS）作为十二指肠转位术（DS）的一种更简单且可能更安全的术式被引入。它是一种近端十二指肠-回肠端侧单吻合旁路术并联合袖状胃切除术。在本研究中，我们比较了胆胰分流十二指肠转位术（BPD-DS）和SIPS术后2年的结果。
这是一项来自单一私立机构的单一外科医生的回顾性分析。
我们回顾性分析了182例患者的数据，2011年9月至2015年3月期间，62例患者接受了BPD-DS手术，另外120例患者接受了SIPS手术。进行了亚组分析，比较两种手术的数据以评估体重减轻情况和并发症。
182例患者中，156例患者术后超过1年，99例患者术后超过2年。5例患者失访。我们的患者均无导致死亡的并发症。BPD-DS和SIPS在术后3个月时体重减轻情况在统计学上相似，但在术后6、9、12、18和24个月时，BPD-DS的超重体重减轻百分比（%EWL）高于SIPS。BPD-DS和SIPS手术2年后，患者的平均体重指数（BMI）分别下降了23.3（随访率：69%）和20.3kg/m²（随访率：71%）。然而，接受SIPS手术的患者手术时间明显更短，住院时间更短，围手术期和术后并发症比BPD-DS更少（P<0.001）。有趣的是，尽管BPD-DS患者体重减轻略多，但SIPS组的实际最终BMI低于BPD-DS组（25.6对26.9）（P<0.05）。两组术后营养数据如维生素D、B1、B12、血清钙、空腹血糖、糖化血红蛋白（HbA1C）、胰岛素、血清白蛋白、血清总蛋白和血脂谱无统计学差异。
SIPS是一种简化的DS手术。SIPS消除了一个吻合口，与BPD-DS相比，围手术期和术后并发症更少，手术时间和住院时间更短，2年时营养结果相似。然而，BPD-DS的体重减轻更多。一个合理的批评是，绝大多数BPD-DS病例是在SIPS病例之前进行的。因此，在观察术后并发症时，经验和学习曲线不能被完全忽视。
