title: Clinical outcomes of duodenal switch with a 200-cm common channel: a matched, controlled trial.
abstract: BACKGROUND
  Biliopancreatic diversion with duodenal switch (BPD-DS) with a 100-cm common channel has been our treatment of choice for morbid obesity since the early 1990s. This procedure offers excellent long-term weight loss but can be associated with significant side effects.
  
  
  OBJECTIVE
  To assess the effect on clinical and nutritional parameters of increasing the common channel to 200 cm.
  
  
  METHODS
  University-affiliated tertiary care center.
  
  
  METHODS
  Patients who underwent a BPD-DS with a 200-cm common channel (study group, n = 36) were matched 1:1 for age, sex, body mass index (BMI), and main co-morbidities with patients who underwent a BPD-DS with a 100-cm common channel (control group). The strict alimentary limb was 150 cm in both groups.
  
  
  RESULTS
  The mean age was 55±9 versus 53±7 years (P = .3), with 50% women and a BMI of 49±8 kg/m(2) versus 50±6 kg/m(2) (P = .9). Follow-up rate was 97%, with a minimum follow-up of 3 years. There were no significant differences in the remission rate of major co-morbidities between the 2 groups. At 3 years, the excess weight loss was 61±22% versus 68±18% (P = .18) and the total weight loss was 33±11% versus 38±9% (P = .055) in the study group versus control group, respectively. The study group had a lower incidence of severe protein deficiency (11% versus 19%, P = .3) and hyperparathyroidism (17.1% versus 35.3%, P = .17); required a lower amount of vitamins A and D (P<.05); and had a decreased number of daily bowel movements (2.0 versus 2.9, P = .03).
  
  
  CONCLUSIONS
  In this population, BPD-DS with a 200-cm common channel offered similar remission rate of co-morbidities compared with standard BPD-DS. It was associated with similar weight loss at nadir, followed by a more significant weight regain. It might yield a lower rate of nutritional complications. Long-term randomized data are needed to detect other potential advantages.
authors.affiliation: Institut Universitaire de Cardiologie et de Pneumologie de Québec, Department of Surgery, Division of Bariatric and General Surgery, Laval University, Quebec City, Quebec, Canada. Electronic address: stefanelebel@gmail.com.
authors.forename: Stéfane
authors.initials: S
authors.lastname: Lebel
authors.affiliation: Institut Universitaire de Cardiologie et de Pneumologie de Québec, Department of Surgery, Division of Bariatric and General Surgery, Laval University, Quebec City, Quebec, Canada.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Dion
authors.affiliation: Institut Universitaire de Cardiologie et de Pneumologie de Québec, Department of Surgery, Division of Bariatric and General Surgery, Laval University, Quebec City, Quebec, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Marceau
authors.affiliation: Institut Universitaire de Cardiologie et de Pneumologie de Québec, Department of Surgery, Division of Bariatric and General Surgery, Laval University, Quebec City, Quebec, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Biron
authors.affiliation: Institut Universitaire de Cardiologie et de Pneumologie de Québec, Department of Surgery, Division of Bariatric and General Surgery, Laval University, Quebec City, Quebec, Canada.
authors.forename: Maud
authors.initials: M
authors.lastname: Robert
authors.affiliation: Institut Universitaire de Cardiologie et de Pneumologie de Québec, Department of Surgery, Division of Bariatric and General Surgery, Laval University, Quebec City, Quebec, Canada.
authors.forename: Laurent
authors.initials: L
authors.lastname: Biertho
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D001361:Avitaminosis / Q000209:etiology; D050110:Bariatric Surgery / Q000009:adverse effects / Q000379:methods*; D015904:Biliopancreatic Diversion / Q000379:methods*; D008078:Cholesterol, LDL / Q000378:metabolism; D004386:Duodenum / Q000601:surgery*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006961:Hyperparathyroidism / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009748:Nutrition Disorders / Q000209:etiology; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011488:Protein Deficiency / Q000209:etiology; D012709:Serum Albumin / Q000378:metabolism; D015431:Weight Loss / Q000502:physiology
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D012709:Serum Albumin
keywords: Bariatric surgery; Biliopancreatic diversion; Duodenal switch; Metabolic surgery