title: Two-step laparoscopic duodenal switch for superobesity: a feasibility study.
abstract: BACKGROUND
  The laparoscopic duodenal switch (LDS) is a complex bariatric procedure that can be split into two steps to lower the rate of morbidity and mortality. This strategy also identifies patients who do not require the second malabsorptive step to achieve substantial weight loss.
  
  
  METHODS
  From October 2005 to January 2008, 77 superobese patients underwent laparoscopic sleeve gastrectomy. The 15 patients (19.5%) who underwent the second step (LDS) up to March 2008 are the subjects of the current study. The indications for the second step were insufficient weight loss (<50% of excess weight [EW]), progressive weight regain, and persistence of comorbidities.
  
  
  RESULTS
  The mean initial body mass index (BMI) was 54 kg/m(2) (range, 50.7-59 kg/m(2)), and the mean EW was 84.8 kg (range, 57-111 kg). There were 21 comorbid conditions experienced by 8 of 15 patients. The two-step procedure resulted in a mean BMI of 39 kg/m(2), an excess weight loss (%EWL) of 47.6%, and an excess BMI loss (%EBL) of 51.7% at 1 month. The respective values were 35.6 kg/m(2), 57.6%, and 63.4% at 3 months and 33.1 kg/m(2), 64.6% and 72% at 6 months. There were no deaths, and only one postoperative complication was recorded (strangulated incisional hernia), for a complication rate of 6.7%. Of the 21 comorbid conditions recorded before surgery, namely, hypertension (n = 6), sleep apnea syndrome (n = 4), diabetes (n = 4), joint disease (n = 3), dyslipidemia (n = 4), hypertension remained unchanged in one case and improved in three cases after the two-step LDS. One patient still needed insulin, but the dose decreased from 500 to 100 IU/day.
  
  
  CONCLUSIONS
  Two-step LDS is feasible, safe, and effective. It leads to substantial weight loss and improvement in comorbidities over the short term for superobese individuals.
authors.affiliation: Service de Chirurgie Digestive et Transplantation Hépatique, Hôpital Archet 2, 151 Route Saint Antoine de Ginestiere, BP 3079, 06202, Nice, France. antonio_iannelli@hotmail.com
authors.forename: Antonio
authors.initials: A
authors.lastname: Iannelli
authors.forename: Anne Sophie
authors.initials: AS
authors.lastname: Schneck
authors.forename: Moucef
authors.initials: M
authors.lastname: Dahman
authors.forename: Chiara
authors.initials: C
authors.lastname: Negri
authors.forename: Jean
authors.initials: J
authors.lastname: Gugenheim
mesh_terms: D000328:Adult; D015992:Body Mass Index; D004386:Duodenum / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D016896:Treatment Outcome; D015431:Weight Loss