Duodenal switch without gastric resection: results and observations after 6 years.
BACKGROUND
The results on metabolic effects of the classical biliopancreatic diversion (BPD) have led us to investigate the operation without gastric resection, thus preserving stomach and pylorus, in patients who are not seriously obese but suffer from hypercholesterolemia, often associated with type 2 diabetes and hypertriglyceridemia.


METHODS
Between 1996 and 1999, we performed the duodenal switch (DS) without gastric resection on 24 mildly obese patients. Mean preoperative BMI was 36.2 kg/m(2). 17 patients (70.8%) suffered from type 1 diabetes, 4 (16.6%) had impaired glucose tolerance, while the remainder had fasting hyperglycemia. In 20 patients (83.3%), hypercholesterolemia and alterations in lipid profile were present. Another 20 patients were taking drugs for arterial hypertension. The pluri-metabolic syndrome was present in 41.6% of patients.


RESULTS
Mean follow-up was 4 years. BMI reduction and weight loss were not large. 2 patients who had severe longstanding diabetes type 2 needed a second operation of the classical BPD because of failure in improving diabetes. Another 2 patients were changed to classical BPD because of a relapsing chronic duodeno-ileal ulcer. The incidence of ileal ulcer was 29.1%. Regarding hypercholesterolemia, hypertrigliceridemia, and type 2 diabetes when there is a good pancreatic "reservoir", the operation seems effective in the long-term. Protein absorption is better than that obtained with the classical BPD.


CONCLUSIONS
Our long-term results suggest that in carefully selected patients suffering from serious hypercholesterolemia or type 2 diabetes with insulin reserves still at an acceptable level, and with BMI 30-40, DS without gastric resection can be proposed as a surgical treatment for metabolic diseases but not for obesity.
Cossu
Maria Laura
ML
Centro di Chirurgia Generale e Della Grande Obesita', Policlinico Universitario, Italy. Urgenza@ssmain.uniss.it
Noya
Giuseppe
G
Tonolo
Gian Carlo
GC
Profili
Stefano
S
Meloni
Giovanni B
GB
Ruggiu
Matteo
M
Brizzi
Patrizia
P
Cossu
Franca
F
Pilo
Luca
L
Tilocca
Pier Luigi
PL
D000328:Adult; D015904:Biliopancreatic Diversion / Q000379:methods*; D015992:Body Mass Index; D004386:Duodenum / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss