Background

Sleeve gastrectomy (SG) represents the predominant bariatric surgery worldwide. However, a significant portion of patients experience insufficient weight loss (IWL) or weight regain (WR) after SG. We present our findings on second-stage Duodenal Switch (2sDS) after SG for patients with IWL or WR.

Methods

This is a single-center cohort analysis from a tertiary care center with data from a prospectively maintained database of all patients undergoing metabolic surgery. Patients who underwent 2sDS, with 100cm common channel and a 150cm alimentary limb between August 2019 and May 2022, with a minimum follow-up of 2 years were included. Primary outcomes were excess weight loss (EWL), total weight loss (TWL), and BMI. Secondary outcomes were changes in obesity related comorbidities, protein malnutrition, and mortality. Data is reported as Mean +-Standard deviation or percentage.

Results

A total of 175 patients underwent 2sDS, with an initial BMI of 43+-0.6g/m2, sex ratio (F/M) of 115/60%, age of 46.5+-0.8 years and follow-up of 65.4 months. Weight prior to SG was 148.8+-2.6kg, 119.3+-1.9kg prior to 2sDS and a last weight at 91.3+-1.6kg with TWL of 38.1%. The remission rate of type 2 diabetes was 88.5%, obstructive sleep apnea 57%, hypertension 59.8%, and dyslipidemia 71.6%. The rate of protein malnutrition (Albumin under 25g/l) was 1.1%. There were no 90-day mortalities but 3 (1.7%) long term.

Conclusions

Second-stage DS offers excellent weight loss and remission rate of comorbidities, for patients experiencing IWL or WR after SG. This option should be considered as a treatment option for failed SG patients.