title: Laparoscopic sleeve gastrectomy: with or without duodenal switch? A consecutive series of 800 cases.
abstract: BACKGROUND
  Sleeve gastrectomy (SG) was originally performed as the restrictive and acid-reducing part of a biliopancreatic diversion with duodenal switch (BPD-DS). It is now recognized as a stand-alone procedure, but direct comparison between the two procedures is still lacking. The goal of this study is to compare the outcomes of the two procedures and their respective impact on obesity-related comorbidities.
  
  
  METHODS
  All patients who had a laparoscopic SG (n = 378) or a laparoscopic BPD-DS (n = 422) before 10/2011 were included in this study (n = 800). Data were obtained from our prospectively maintained electronic database and are reported as mean ± standard deviation comparing SG with BPD-DS patients.
  
  
  RESULTS
  SG patients were older (48 ± 11 vs. 40 ± 10 years, p < 0.001) with a higher prevalence of comorbidities (type 2 diabetes mellitus in 51 vs. 37%; hypertension 62 vs. 49%; sleep apnea 63 vs. 51%; all p < 0.001). Initial BMI was 48 ± 9 vs. 48 ± 6 (p = 0.8). There was one 30-day mortality in the BPD-DS group, from a pulmonary embolism, for an overall mortality rate of 0.13%. Thirty-day complications occurred in 6 vs. 8% of patients (p = 0.2), including gastric leaks in 4 (1%) vs. 0 patients (p = 0.049). Mean follow-up was 29 ± 10 months. Excess weight loss was 45 ± 14 vs. 62 ± 15% at 6 months, 53 ± 18 vs. 81 ± 14% at 12 months, 53 ± 23 vs. 87 ± 15% at 18 months, 50 ± 19 vs. 86 ± 15% at 24 months and 51 ± 24 vs. 83 ± 16% at 36 months (p < 0.05 for all time points). The surgery induced the remission of type 2 diabetes mellitus in 56 vs. 90% of patients, hypertension in 54 vs. 76% and sleep apnea in 43 vs. 74% (all p < 0.05). In type 2 diabetic patients, fasting plasma glucose decreased by -1.9 mmol/l after SG vs. -2.9 mmol/l after BPD-DS (p < 0.05) and hemoglobin A1C by -1.1 vs. -1.9% (p < 0.05).
  
  
  CONCLUSIONS
  SG results in a significant 3-year weight loss and remission of comorbidities. BPD-DS provides further improvement of associated comorbidities and can be an option for the management of insufficient weight loss or residual comorbidities following SG.
authors.affiliation: Division of Bariatric and Metabolic Surgery, Department of Surgery, Quebec Heart and Lung Institute, Quebec, Que., Canada.
authors.forename: L
authors.initials: L
authors.lastname: Biertho
authors.forename: S
authors.initials: S
authors.lastname: Lebel
authors.forename: S
authors.initials: S
authors.lastname: Marceau
authors.forename: F S
authors.initials: FS
authors.lastname: Hould
authors.forename: O
authors.initials: O
authors.lastname: Lescelleur
authors.forename: P
authors.initials: P
authors.lastname: Marceau
authors.forename: S
authors.initials: S
authors.lastname: Biron
mesh_terms: D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology / Q000601:surgery; D004386:Duodenum / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000601:surgery*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012891:Sleep Apnea Syndromes / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome