Evaluation of Outcomes of Duodenal Switch Operations for Morbid Obesity and Metabolic Syndrome

Abstract

Obesity was described as a clinical problem many years ago even in the ancient medical writings and now is considered to be pandemic. Obesity now is considered a disease not only accumulation of body in excess and is assessed by the body mass index. There are many factors that play role in the development of obesity, such as: genetic factors, eating disorders, endocrinal causes, psychogenic problems, behavioral changes and usage of certain drugs. Obesity is associated with many diseases such as diabestes mellitus, hypertension, cardiovascular diseases, obstructive sleep apnea, arthritis and others. The metabolic syndrome is a combination of diabetes plus two of any of the following: morbid obesity, hypertension, hypertriglyceridemia, or hypercholesterolemia. Weight loss improves diabetes and several risk factors for cardiovascular diseases, but anti-obesity medications and lifestyle interventions usually fail to do this. Here, the role of metabolic surgeries comes. So, the bariatric surgery has been recognized to be metabolic surgery. Procedures can be designated as restrictive, restrictive/malabsorptive and malabsorptive. Duodenal switch operations are indicated in treatment of morbid obesity, especially in the super-super obese patients. Duodenal switch operations give the best results in treatment of diabetes mellitus. Contraindications include preexisting potentially malabsorptive disorder, gastroesophageal reflux disease, inability to maintain follow-up, financial inability to purchase postoperative vitamin supplements and others. Duodenal switch needs high surgical skills due to its difficult surgical techniques compared to other bariatric surgeries. But duodenal switch was simplified in another procedure known as single anasomosis duodeno-ileal bypass with sleeve gastrectomy, which has good results in treatment of obesity and the metabolic syndrome. The most recent simplification was performed in USA, known as: stomach intestinal pylorus sparing surgery. The early results of this operation were published in 2016 and were satisfactory but need further follow-up. Postoperative complications include: leakage, vitamin and micronutrient deficiencies, protein calorie malnutrition, intestinal obstruction, chronic diarrhea and others. Although duodenal switch has higher operative mortality rates, some authors found that these rates are lower in centers with higher volume of duodenal switch operations. Duodenal switch is very efficient in terms of cure rate for morbid obesity and its comorbidities. In terms of risk/benefit, duodenal switch is very successful with an appropriate system of follow-up. Duodenal switch provides excellent weight loss with preservation of good alimentation. This is accomplished with acceptable operative mortality and minimal dietary limitations and metabolic sequelae. The results of the duodenal switch should remove any inhibitions that exist about the use of this procedure as treatment for patients who have morbid obesity.