Original article
A retrospective comparison of biliopancreatic diversion with duodenal switch with single anastomosis duodenal switch (SIPS-stomach intestinal pylorus sparing surgery) at a single institution with two year follow-up

https://doi.org/10.1016/j.soard.2016.11.020Get rights and content

Abstract

Background

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.

Setting

This is a retrospective analysis from a single surgeon at a single private institution.

Methods

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.

Results

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/m2 (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.

Conclusion

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.

Section snippets

Aim

This study compares the midterm outcomes in terms of weight loss and complications of laparoscopic BPD-DS versus SIPS at a single institution at 2 years.

Methods

With adherence to HIPAA guidelines, 182 patients had undergone laparoscopic BPD-DS or SIPS procedure were retrospectively reviewed from a prospectively collected database. All patients were informed about the various surgical procedures for weight loss at an educational seminar before their individual evaluation in the clinic. Each patient had an informed consent to participate in our de-identified database. Each patient signed informed consent detailing the procedure, risks, and potential

Results

There were 182 patients that qualified for the study. Of these, 62 patients underwent BPD-DS between September 2011 and August 2013, while the other 120 patients underwent SIPS between June 2013 and March 2015. Out of 182 patients, 5 patients lost to follow-up. One hundred fifty-six patients are beyond 1 year postoperative mark and 99 patients are beyond 2 year postoperative mark. See Table 1, Table 2 for demographic data and operative details for BPD-DS and SIPS, respectively.

Short-term

Discussion

BPD and DS are most effective bariatric procedures for weight loss and for selective metabolic diseases [14], [15], [16]. Despite these advantages, they are technically demanding operations with greater concerns for malnutrition, diarrhea, and other adverse consequences, particularly if patients are lost to follow up [17].

This is the first paper which compares the outcomes of the classic Roux-en-Y version of DS (BPD-DS) to single anastomosis version of DS (SIPS). Our results demonstrate

Conclusion

The SIPS is a simplified DS procedure that is safe and has significantly shorter operative time, shorter length of stay, and fewer perioperative and postoperative complications than BPD-DS. 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. The SIPS offers the patients the opportunity to take any

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

References (30)

  • B. Anderson et al.

    Biliopancreatic diversion: the effectiveness of duodenal switch and its limitations

    Gastroenterol Res Pract

    (2013)
  • D.S. Hess et al.

    Biliopancreatic diversion with a duodenal switch

    Obes Surg

    (1998)
  • P. Marceau et al.

    Biliopancreatic diversion with a new type of gastrectomy

    Obes Surg

    (1993)
  • H. Zaveri et al.

    Stomach intestinal pylorus sparing surgery (SIPS) with laparoscopic fundoplication (LF): a new approach to gastroesophageal reflux disease (GERD) in the setting of morbid obesity

    SpringerPlus

    (2015)
  • A. Sanchez-Pernaute et al.

    Proximal duodenal–ileal end-to-side bypass with sleeve gastrectomy: proposed technique

    Obes Surg

    (2007)
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