Safety and Feasibility of Laparoscopic Sleeve Gastrectomy with Loop Duodenal Switch Surgery for Obesity in Indian Patients

Abstract

Aim: Laparoscopic sleeve gastrectomy with loop duodenal switch (SLDS) surgery is a loop modification of biliopancreatic diversion with duodenal switch (BPD-DS) aimed at reducing malabsorption without compromising on the efficacy. This study aimed to analyze the safety and feasibility of SLDS surgery in Indians suffering from obesity. Materials and methods: This was a retrospective study analyzing 169 patients who underwent SLDS surgery between November 2013 and June 2020. The cohort was divided into two subgroups based on the common channel length-2.5 and ≥3 m. Weight-loss parameters, diabetes remission, and investigations at 6 months and 1 year follow-up were analyzed in the total cohort and common channel subgroups. The percentage of total weight loss (%TWL) ≥25% was considered as a successful weight-loss outcome. HbA1C <6% without the need for antidiabetic medications was considered as complete diabetes remission. Safety was analyzed in terms of intraoperative and postoperative complications. Results: Mean preoperative body mass index was 45.39 ± 7.6 kg/m 2 . 48.52% of the patients were suffering from type II diabetes. Mean %TWL was 30.91 ± 4.98 and 41.86 ± 7.63% and complete diabetes remission was 81.82 and 89.06% at 6 months and 1 year follow-up, respectively. The percentage of total weight loss was inversely proportional to the common channel length. Complete diabetes remission was not significantly affected by the common channel length. Serum albumin <3 gm/dL was significantly high in patients with a common channel length of 2.5 vs ≥3 m-25 vs 4.65% at 6 months and 40 vs 7.14% at 1 year follow-up, respectively. Thirty-day mortality was zero. Conclusion: Sleeve gastrectomy with loop duodenal switch surgery appears to be effective and safe in Indian patients. Malabsorption risk is greatly reduced when the common channel length is ≥3 m. Clinical significance: Sleeve gastrectomy with loop duodenal switch surgery with the common channel length ≥3 m simplifies BPD-DS, gives excellent weight loss and diabetes remission with minimal malabsorption. Restricting the biliopancreatic limb to ≤55% prevents adverse malabsorptive consequences.