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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November 2016 • Supplement B • Bariatric Times B7 FIRST INTERNATIONAL CONSENSUS CONFERENCE ON DUODENAL SWITCH (malodorous flatus, steatorrhea), but there are also important mineral and vitamin deficit that can adversely affect patient health. Sethi et al 6 recently published their experience with BPD and BPD/DS over 10 years within an academic, university hospital setting in the United States. Long- term weight loss was substantial and sustained (% excess weight loss [EWL] of 70%), with only a small percentage of inadequate weight loss (23%). At a mean of 7.7 years postoperatively, remission of comorbidities was 65 percent for hypertension, 40 percent for gastroesophageal reflux disease (GERD), 58 percent for diabetes, and 75 percent for hyperlipidemia. Thirty-seven percent of patients developing complications required surgery over the course of the study. The most common subjective postoperative complaints were malodorous stool (89%), diarrhea (81%), oily incontinence (70%), fatigue (59%), food intolerance (51%), and hair loss (47%). We recently began to look at our DS patients outcomes and realized that this was a daunting task. Patient follow up in all bariatric practices is complicated. We found that our data set showed follow up at many different time points and not all patients were represented at all time points. Moreover, patients often did not present for years and then came to the office when health problems occurred. It became apparent that there is quite a difference between long-term follow up (up to 9 years) and the issues (complications) that present at 1 to 2 years after this operation. This has a particular pertinence as we are likely approaching a cusp in our current area of bariatrics where the sleeve gastrectomy, our most popular operation, will start to show a significant percentage of weight and comorbidity recidivism. Our DS data presented at ASMBS in November 2015 and published in Obesity Surgery 7 on the long-term results of about 275 patients parallels that of other previously published studies showing sustained weight loss, comorbidity improvement (particularly diabetes and dyslipidemia [Table 2]); and improvement of SF-36 and quality of life (QoL) parameters (Table 3 and Table 4). Although we believe our patients were selected to be "compliant" with postoperative Table 2. Percentage of Abnormal Values for Diabetes Mellitus and Dyslipidemia Pre- and Post-Surgery BASELINE 1 YEAR 3 YEARS 5 YEARS 7 YEARS 9 YEARS A NOVA P VALUES HemoglobinA1c >5.6% (Sethi et a l) 6 34/59# 57.6% 2/93 2.2% <.0001* 2/78 2.6% 1.0000 2/71 2.8% 1.0000 0/65 0.0% 0.4973 0/54 0.0% <.0001 Cholesterol ≥ 200 mg/dl 59/132 44.7% 8/172 4.7% <.0001 3/171 1.8% 0.1279 2/53 3.8% 0.3387 5/79 6.3% 0.7013 1/52 1.9% 0.4016 <.0001 Triglycerides ≥ 150 mg/dl 41/104 39.4% 19/166 11.4% <.0001 14/156 9.0% 0.4649 6/190 5.5% 0.2927 6/80 7.5% 0.5783 4/51 7.8% 1.0000 <.0001 High Density Lipo-Proteins ≤ 40 mg/dl 24/97 24.7% 49/117 41.9% 0.0085 25/119 21.0% 0.0005 28/102 27.5% 0.2635 21/78 26.9 0.9372 11/51 21.6% 0.4912 <.0078 Low Density Lipo-Proteins ≥ 100 mg/dl 24/92 26.1% 5/115 4.3% <.0001 3/116 2.6% 0.4991 0/102 0.0% 0.2497 0/79 0.0% 0/50 0.0% <.0001 Cholesterol/High Density Lipo- Protein Ratio ≥5.0 19/81 23.5% 7/88 8.0% 0.0053 3/97 3.1% 0.1966 0/75 0.0% 0.2580 1/61 1.6% 0.4485 0/38 0.0% 1.0000 <.0001 # Number/Cohort total number; *P values for cohort comparisons Reprinted with permission from Strain GW, Torghabeh MH, Gagner M, et al. The impact of biliopancreatic diversion with duodenal switch (BPD/DS) over 9 years. Obes Surg. 2016 Sep 29. [Epub ahead of print ]

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