Loop Duodenal Switch Info Video
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Gastric bypass and duodenal switch are currently performed bariatric surgical procedures. Uncontrolled studies suggest that duodenal switch induces greater weight loss than gastric bypass. To determine whether duodenal switch leads to greater weight loss and more favorable improvements in cardiovascular risk factors and quality of life than gastric bypass.
The primary outcome was the change in BMI after 2 years. Secondary outcomes included anthropometric measures; concentrations of blood lipids, click, insulin, C-reactive protein, and vitamins; and health-related quality of life and adverse events.
The mean reductions in BMI were Total cholesterol concentration decreased by 0. Both groups had reductions in blood pressure and mean concentrations of glucose, insulin, and C-reactive protein, with Chicago Dating Service Matchmaking Duodenal Switch Revision between-group differences.
The duodenal switch group, but not the gastric bypass group, had reductions in concentrations of vitamin Chicago Dating Service Matchmaking Duodenal Switch Revision and hydroxyvitamin D. Most Short Form Health Survey dimensional scores improved in both groups, with greater improvement in 1 of 8 domains bodily pain after gastric bypass. Adverse events related to malnutrition occurred only after duodenal switch.
Clinical experience was greater with gastric bypass than with duodenal switch at the study centers. Duodenal switch surgery was associated with greater weight loss, greater reductions of total and low-density lipoprotein cholesterol concentrations, and more adverse events. Improvements in other cardiovascular risk factors and quality of life were similar after both procedures.
Two types of bariatric surgery are commonly used to treat severe obesity: Few controlled clinical trials of these procedures have been reported. After 2 years, duodenal switch resulted in significantly greater reduction in body mass index than gastric bypass but was more commonly associated with adverse events. Dietary factors, quality of life, and cardiovascular markers varied with each procedure. Patients benefited from both types of bariatric surgery. The choice of procedure should be individualized.
Bowel limb lengths for gastric bypass: Bowel limb lengths for duodenal switch: Participant Characteristics at Baseline. Estimated postsurgery values are expected means from the linear mixed-effects models. Observed Baseline and Estimated Postsurgery Measurements.
Values for participants who used insulin were excluded 1 in the gastric bypass group at all time points and 1 in the duodenal switch group at baseline.
Estimated postsurgery values are expected means from the linear mixed-effects models; a score of 0 represents worst possible health and represents best possible health.
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Unauthorized use of the In the Clinic slide sets will constitute copyright infringement. Ledtter to the Editor: Bypassing Bariatric Surgery and Editorial Evidence. The journal published a rarity: One might question equality of the two hospitals, equivalency of the teams' learning curves, follow-up schedules lacking postoperative "dietitian and surgeon" visits during the important months after bypass operations in superobese patients and drawing conclusions after only 2 years when slopes of the mean BMI diverge in groups with different follow-up rates, and particularly too early to evaluate the most valuable benefits of these operations.
However, the accompanying Editorial 4 raises more serious questions:. Should all malabsorptive operations be branded as "inherently dangerous"?
Gastrointestinal surgery is "dangerous" yet meets risk-benefit and cost-benefit criteria or else would not be allowed? Can outcomes of treatments of superobese patients be evaluated after only 2 years?
No 2-year evidence supports stating: Predictions before weight and compensatory adaptive mechanisms have stabilized are unfounded. There is no evidence that "Many patients are well-adapted to their obesity"; neither superobese patients in general nor 'bariatric surgery' patients. The editorial criticizes the "low methodological quality" of studies of bariatric surgery and requests "good evidence", yet describes a rare complication as "particularly worrisome for these young women" based on one case-report 5.
Not to trivialize this, but the complication is rare and easily prevented by standard of care following authoritative guidelines editorial refs 3 and 4. Both operations have been performed for 35 years with large series exceeding 15 years, including two with offspring of mothers with the potentially more "dangerous" of the operations followed for years.
The complications are known, this web page to gastrointestinal surgery, but most important: They are easily preventable by competent follow-up care and are substantially easier to treat effectively than superobesity or less extreme forms of obesity.
In the final analysis patients must decide whether effects of these operations, beneficial or check this out, outweigh their own suffering with their disease. Responsible physicians must provide the best available understandable evidence to lay patients. Sovik TT et al. Weight loss, cardiovascular risk factors and quality of life after gastric bypass and duodenal switch.
Ann Intern Med ; Kral JG et al. Flaws in methods of evidence-based medicine may adversely affect public health directives. Vitamin A deficiency an a Chicago Dating Service Matchmaking Duodenal Switch Revision resulting from maternal hypovitaminosis A after biliopancreatic diversion for the treatment of morbid obesity. Am J Clin Nutr. Sovik and colleagues 1 are to be congratulated on performing one of the few RCTs comparing bariatric surgical procedures, but their paper has serious flaws which were not identified in the accompanying editorial 2 nor the subsequent reports in other journals 3 and specialist websites.
What Sovik's data actually illustrates is that if duodenal switch DS is performed on randomly instead of carefully selected patients by relatively inexperienced surgeons and if patients are then given sub- optimal vitamin replacement more suited to a short-limb Roux-en-Y gastric bypass and infrequent follow-up, post-operative problems are not uncommon.
In fact with this study design it was remarkable that so few adverse events were seen. Our experience of DS patients followed for up to 5 years 4 confirmed Sovik's report that the DS is indeed associated with reversible nutritional deficiencies particularly vitamin D.
However, we and others recognize that the DS is not a universally applicable operation because it requires an exceptional level of post-operative patient compliance.
Few patients are capable of this and without careful selection problems can occur, particularly if, as in this study, their nutrition is only being monitored once every months during the crucial mid-late post- operative period.
The very notion of randomizing potentially non-compliant patients to a DS is flawed. Their current paper confirms this to be the case as only an additional 4 gastric bypass and 7 DS patients developed complications between 30 days and 1 year post-op.
In year two, a further 5 gastric bypass patients developed adverse events, compared to just 3 DS patients two due to trauma rather than surgery. The DS is a technically challenging procedure and mandates a strict post-operative regime with intensive support from the bariatric team. It is clear that to keep the frequency of adverse events to a minimum in the early and late post-operative periods the DS should only be offered to carefully selected patients treated in specialist centres.
Sovik's paper simply confirms this and adds little more. Weight loss, cardiovascular risk factors, and quality of life after gastric bypass and duodenal switch: Duodenal Switch is a poor choice in super obese adults.
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Outcome of laparoscopic duodenal switch for morbid obesity. Randomized clinical trial of laparoscopic gastric bypass versus laparoscopic duodenal switch for superobesity. Those of us who have dedicated ourselves to offering the entire arsenal in weight loss surgery have come to understand the important role the Duodenal Switch has in the Super Obese patient and in the future of Bariatric Surgery.
Early and late post-operative morbidity was not statistically significant.
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The authors comment that there is a tendency toward protein malnutrition in the DS patient. The authors offer an unusually aggressive construction of the DS. The Sleeve component is more aggressive than a standard VSG. The Sleeve component of a standard DS procedure is usually created larger than a standard sleeve anticipating significant contribution to weight loss by the diversionary component of the procedure.
A Common Channel of cm plus an aggressive sleeve is a set up for excessive weight loss and serious sequale of protein malnutrition. Intense nutritional follow up with specific instruction on adequate protein supplementation, hydration, and vitamin supplement is paramount. It is probable that the majority of the GBP patients in this study will regain weight and comorbid disease will return.
May you please prolong them a bit from next time? But before your on your next jury and yell 'Null! Any one of many following blood tests may be ordered:
The construction of the DS in this study will lead to predictable and serious nutritional consequences in the DS patients in this study. The DS is superior in the Super Obese.
We cannot continue to ignore inadequate weight loss and high rate of recidivism in the super obese patient after GBP. Experience and a comprehensive nutrition program achieve safe results. Standardization of procedures and nutritional protocol are necessary to study procedures accurately. Weight loss, cardiovascular risk factors, and quality of life after gastric bypass and duodenal switch.
Loop Duodenal Switch Info Video
However, we have some comments on the paper. The selection criteria for different bariatric techniques are not well defined and are usually based on psychiatric statement, body weight and relative surgical risk. The authors didn't clarify if the patients underwent psychiatric assessment, which were the criteria used for the eligibility of the bariatric surgery options. As clearly discussed by Sovik and colleagues, duodenal switch surgery should be restricted to well -informed super obese patients who are likely to adhere to clinical follow -up.
As a consequence, the patients should be carefully selected instead of being randomized. In this case the randomization procedure raises important ethical concerns that may be overcome with case-control study design 2. Since fat distribution more than the total amount of fat is critical in defining cardiovascular risk and insulin resistance, an evaluation of fat distribution in both visceral and peripheral sites through either a surrogate marker here waist to hip ratio or direct measurements of the different body compartments by DXA analysis of body composition is advisable in order to assess the quality of weight loss 3.
Furthermore, the calculation of the HOMA-IR index would have more likely better characterized the changes of insulin resistance rather than fasting glucose and insulin serum concentrations values.
Faecal excretion of cholesterol is one of the main mechanisms through which malabsorptive techniques can reduce circulating total, LDL and HDL cholesterol 4. The authors show a greater LDL reduction after duodenal switch, but the reported increase of HDL cholesterol appears not significant; on the contrary, the HDL cholesterol values are clearly increased in the gastric bypass group. It is difficult to explain why both gastric bypass and duodenal switch patients showed a superimposable increase of PTH whilst only duodenal switch patients were vitamin D deficient.