Retrograde filling of the afferent limb as a cause of chronic nausea after single anastomosis loop duodenal switch

Surve, Amit; Zaveri, Hinali; Cottam, Daniel

doi:10.1016/j.soard.2016.01.018

Cited by 25 publications

(6 citation statements)

References 7 publications

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“…Only one complication was related to the loop configuration where there was preferential flow into the afferent limb [24]. This was treated by laparoscopy and a pexy stitch to prevent backflow.…”

Section: Discussionmentioning

confidence: 99%

Single Anastomosis Duodenal Switch: 1-Year Outcomes

Cottam¹,

Roslin

Enochs³

et al. 2020

OBES SURG

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Introduction Single-anastomosis duodenal switch has been suggested to be an effective bariatric procedure that offers excellent weight loss and by lengthening the common channel the potential to reduce micronutrient deficiencies. Purpose To evaluate the weight loss, comorbidity resolution and the 1-year nutritional outcomes of the single-anastomosis duodenal switch (SADS) procedure. Setting Multiple US Hospitals. Methods From October 2014 to January 2017, 120 patients were enrolled at six sites across the USA and underwent the SADS procedure. Weight loss, comorbidities, quality of life, and adverse events were followed post-procedure for 12 months. Results At 1, 6, and 12 months, 98.3%, 85.5%, and 77.1% of the patients were available for assessment, respectively. At 12 months, patients showed significantly reduced body mass index when compared to baseline (46.8 ± 5.8 vs 29.8 ± 4.4, P < 0.001 respectively). Sixty-five patients had type 2 diabetes at baseline; however, 11 patients lost to follow-up. Of the available data (54 patients), 96.3% of the patients had a resolution of type 2 diabetes by 12 months with a mean A1C reduction from 7.8 ± 1.6 to 5.3 ± 0.7. Additionally, there were reductions in hyperlipidemia, sleep apnea, and hypertension at 12 months. Patient gastroesophageal reflux disease satisfaction and quality of life (SF-36) scores were significantly higher at 12 months postprocedure (P < 0.001 in all cases) while 12-month protein levels remained at normal values. There were abnormalities of parathyroid hormone and vitamin D at 1 year with all other nutritional markers being not significantly different at 1 year from baseline. There were 10, IIIb, or greater complications according to the Clavien-Dindo scoring system during the study period, not all of which were related to the surgery. Conclusions SADS is a highly efficacious weight loss procedure with significant comorbidity reduction at 1 year. At 1 year, complications and vitamin and mineral deficits appear to be consistent with other malabsorption operations. Long-term follow-up is needed, especially around complications and vitamin deficiencies.

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Section: Discussionmentioning

confidence: 99%

Single Anastomosis Duodenal Switch: 1-Year Outcomes

Cottam¹,

Roslin

Enochs³

et al. 2020

OBES SURG

Self Cite

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“…Recently, there have been several reports on the outcomes of SADI-S procedure [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. One of the articles published by Neichoy et al [16] on the midterm outcomes of SADI-S reported EWL of 88% at 24 months.…”

Section: Discussionmentioning

confidence: 99%

“…Based on clinical knowledge, expert opinion, and published peer-reviewed scientific evidence, the International Federation for the Surgery of Obesity and Metabolic Disorders considered the SADI-S (and its variant [stomach intestinal pylorus-sparing surgery]) an established bariatric procedure [14]. In recent years, there have been few reports on the short-and mid-term outcomes of this procedure [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. In terms of weight loss, the SADI-S and RYGB had statistically similar weight loss; however, the weight loss was statistically higher in patients undergoing SADI-S procedure than SG [21,30].…”

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confidence: 99%

Comparative analysis of the single-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) to established bariatric procedures: an assessment of 2-year postoperative data illustrating weight loss, type 2 diabetes, and nutritional status in a single US center

Enochs

Bull

Surve³

et al. 2020

Surgery for Obesity and Related Diseases

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“…Being a new procedure, there are very little data describing the rare complications of this unique approach or how to fix them [8,9].…”

Section: Discussionmentioning

confidence: 99%

A step-by-step surgical technique video with two reported cases of common channel lengthening in patients with previous stomach intestinal pylorus sparing surgery to treat chronic diarrhea

Surve

Zaveri

Cottam

2017

Surgery for Obesity and Related Diseases

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Surgical procedures are currently the only effective longterm way to treat morbid obesity. However, these procedures all carry risks, with each procedure having its own unique risks.In 2007, Dr. Sanchez in Spain first performed a modification of the traditional duodenal switch using a single anastomosis instead of Roux-en-Y reconstruction with the sleeve done over a 56 French bougie [1]. We have modified this further by creating a smaller sleeve (40 French bougie sizing instead of 56) and less malabsorption (300-cm common channel instead of 250 cm) [2]. We have called this modification "stomach intestinal pylorus sparing" (SIPS) surgery to help differentiate it from the common complication of the traditional Roux-en-Y duodenal switch. The preservation of more intestine, along with the ileocecal valve, reduces the risk for malnutrition and diarrhea often associated with the duodenal switch [3,4]. The lack of a distal small bowel enteroenterostomy should eliminate or decrease the chances of internal hernias. Since 2013, we have performed over 300 SIPS surgeries. However, we have encountered 2 patients that developed chronic diarrhea without malnutrition that resulted in the need for common channel lengthening. Chronic diarrhea was defined as loose stools that last for at least 4 weeks. This usually means 4 or more loose stools per day.We present a step-by-step surgical technique of common channel lengthening (CCL) to treat chronic diarrhea after SIPS surgery. This is the first report in the literature that demonstrates the CCL technique after a SIPS surgery and also reports the first 2 cases. Patient 1A 41-year-old woman with a body mass index (BMI) of 42.9 kg/m 2 had planned SIPS in 2014. Her current BMI is 26.5 kg/m 2 . Six months after surgery, she began to experience smelly flatulence, bloating, and severe diarrhea (6-8 loose stools/d). Her nutritional status (vitamins A, D, E, K, B1, B12, and copper and zinc) was normal. Her albumin and prealbumin were also normal. Dietary intervention and medical interventions of Lomotil and probiotics did not help. Patient 2The second patient was a 63-year-old man with a history of inflammatory bowel syndrome who underwent SIPS surgery a year prior for morbid obesity with insulin dependent diabetes and a BMI of 38.6 kg/m 2 . The patient had remarkable weight loss after the SIPS surgery (current BMI, 22.5 kg/m 2 ) with resolution of pre-existing diabetes and gastroesophageal reflux disease. However, 5 months after surgery the patient began experiencing postprandial diarrhea (6-8 loose stools/d) that was unresponsive to both dietary manipulation and medical interventions of http://dx.

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Retrograde filling of the afferent limb as a cause of chronic nausea after single anastomosis loop duodenal switch

Cited by 25 publications

References 7 publications

Single Anastomosis Duodenal Switch: 1-Year Outcomes

Single Anastomosis Duodenal Switch: 1-Year Outcomes

Comparative analysis of the single-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) to established bariatric procedures: an assessment of 2-year postoperative data illustrating weight loss, type 2 diabetes, and nutritional status in a single US center

A step-by-step surgical technique video with two reported cases of common channel lengthening in patients with previous stomach intestinal pylorus sparing surgery to treat chronic diarrhea

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