Laparoscopic Duodenal Switch Versus Roux-en-Y Gastric Bypass at a High-Volume Community Hospital: a Retrospective Cohort
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ORIGINAL CONTRIBUTIONS
Laparoscopic Duodenal Switch Versus Roux-en-Y Gastric Bypass at a High-Volume Community Hospital: a Retrospective Cohort Study from a Rural Setting Rodolfo J. Oviedo 1
&
Tapan Nayak 2 & Yang Liu 2 & Shixue Zhang 2 & Fengyu Zhao 2
Received: 22 July 2020 / Revised: 29 September 2020 / Accepted: 2 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background The classic duodenal switch (DS) represents a minority of bariatric procedures due to its high complexity and potential for complications. Methods A retrospective chart review was conducted on 100 laparoscopic DS cases from 2014 to 2018 at an accredited program in a rural community hospital and compared to 100 laparoscopic Roux-en-Y gastric bypasses (RYGB). Primary outcomes were 30-day morbidity and mortality. Secondary outcomes included anastomotic leak and remission of type 2 diabetes. Results There were more demographic risk factors for DS. The 30-day morbidity was higher for DS compared to RYGB (31% vs 13%, respectively; p = 0.0037). There was one mortality for DS and none for RYGB. There were statistically significant longer intraoperative times, greater EBL, and greater decrease in BMI for DS. The DS had a lower incidence of anastomotic ulcers (4% vs 13%, respectively; p = 0.0289), with a higher incidence of subsequent surgery beyond 30 days (21% vs 8%, respectively; p = 0.0160). There were 3 anastomotic leaks for DS and none for RYGB, although not statistically significant (p = 0.2463). The DS was more likely to eradicate hypertension, but the RYGB was more likely to eradicate GERD. There were no statistically significant differences for type 2 diabetes remission (92.1% vs 89.5%, respectively; p = 0.7239). Conclusion Laparoscopic DS offers greater weight loss and hypertension remission, with lower incidence of anastomotic ulcers, but at the expense of greater morbidity and need for subsequent surgery, with no significant differences in type 2 diabetes remission when compared to RYGB in a rural community hospital program. Keywords Duodenal switch . Roux-en-Y gastric bypass . Community hospital . Rural . Laparoscopic . Bariatric surgery
Introduction * Rodolfo J. Oviedo [email protected] Tapan Nayak [email protected] Yang Liu [email protected] Shixue Zhang [email protected] Fengyu Zhao [email protected] 1
Houston Methodist Hospital, Department of Surgery, 6550 Fannin St., SM 1661, Houston, TX 77030, USA
2
George Washington University, Department of Statistics, 801 22nd St NW, Washington, DC 20052, USA
Metabolic and bariatric surgery has given rise to high-quality studies that demonstrate its multiple benefits for the treatment of obesity-related co-morbidities to increase quality of life [1, 2]. The application of minimally invasive Enhanced Recovery After Surgery (ERAS) protocols and clinical pathways has enabled surgeons to facilitate better outcomes for patients who undergo metabolic procedures [3]. However, there is a significant level of variability depending on the
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