Bariatric Times

ICCDS-1 2016

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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B30 Bariatric Times • November 2016 • Supplement B FIRST INTERNATIONAL CONSENSUS CONFERENCE ON DUODENAL SWITCH L aparoscopic duodenal switch (DS) was first performed in July 1999 at Mount Sinai Medical Center in New York City. Subsequently, the operation, which included a laparoscopic sleeve gastrectomy, was performed in two stages for high-risk patients at first, and later as a stand-alone operation. After 15 years of this operation laparoscopically and more than 25 years after its open concept initiated by Picard Marceau in Canada and Doug Hess in the United States, I found it to be an appropriate moment to have our first consensus conference on this operation, and choose Quebec City, the cradle of duodenal switch. The operation continued to improve, now most surgeons are performing the upper anastomosis with a hand-sewn technique, some with robotic assistance, Drs. Antonio Torres and Andres Sanchez-Pernaute from Madrid, Spain have modified the operation laparoscopically to include a single ileal anastomosis at 250 cm (initially at 200 cm) in 2007, and Drs. Daniel Cottam from Salt Lake City and Dr Mitchell Roslin from New York City to modify a longer common channel at 300 cm (published series in 2016). On May 28th, in the Centre des Congres of Quebec City, another consensus was attempted, and preliminary results of a questionnaire were presented to the participating audience. We have found that 64 percent performed a standard DS, and 36 percent now perform a new variant (12% Stomach, Intestine, and Pyloric Sparing Surgery [SIPS] and 24% Single Anastomosis Duodeno- Ileostomy [SADI]). The ideal bougie size for a DS appears to be 40-50Fr (43%), and the common channel for a SADI/SIPS is 250-299 cm (72%). There has been a downsizing of the bougie size (from 60 Fr.) perhaps due to longer common channel lengths. Interestingly, DS surgeons no longer favor routine cholecystectomy, as 68 percent do not perform it. I personally do not, and we had demonstrated a rate of subsequent cholecystectomy of 6.5 percent in the following five years if the patient had taken ursodeoxycholic acid for six months after the operation. The average BMI patient operated in the range of 50 to 60 kg/m 2 (79%) and the percentage of patients followed beyond five years is between 50 and 74 percent. The average expected weight loss at five years is between 70 and 79 percent (94% of responders). This appears to be a better result than the standard Roux-en-Y gastric bypass for patients with super- obesity. Concerning complications, the average leak rate from a duodenal anastomosis (the upper or single) is fairly low at 0 to 1 percent (76%), and similarly the leak rate from the sleeve portion is equally low at 0 to 1 percent (81%). Revisions for malnutrition is infrequent, between 0 and 2 percent (52%) or 2 to 5 percent (45%). It appears that ALL participants agreed that DS is the most effective bariatric surgery for both weight loss (100%) and/or for remission of type 2 diabetes (100%). First International Consensus Conference on Duodenal Switch: Preliminary Results of a Questionnaire Survey Michel Gagner, MD, FRCSC, FACS, FASMBS Bariatric Times. 2016;13(11 Suppl B):B30–B31. AUTHOR AFFILIATIONS: Dr. Michel Gagner is Clinical Professor of Surgery, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida and Senior Consultant, Department of Surgery, Hopital du Sacre Coeur, Montreal, Qubec, Canada. ADDRESS FOR CORRESPONDENCE: Dr. Michel Gagner, 315 Place D'Youville, #191, Montreal, QC, Canada, H2Y 0A4; E-mail: Michel Gagner gagner.michel@gmail.com FUNDING AND DISCLOSURES: Dr. Gagner is a speaker for and/or has received honorarium from the following companies: Olympus, Ethicon (Cincinnati, Ohio, United States), Medtronic (New Haven, Connecticut, United States), Medical Innovation Developpement (MID [Dardilly France]), Transenterix (Morrisville, North Carolina, United States), W. L. Gore and Associates, Inc., Boehringer Labs (Phoenixville, Pennsylvania, United States).

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