肥満と減量療法のジャーナル

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Nutritional Markers after Loop Duodenal Switch (SADI-S) for Morbid Obesity: A Technique with Favorable Nutritional Outcome

Atif Abd-Elatif, Tamer Youssef, Mokhtar Farid, Yasser Ali and Walid Gado

Background: A reduction of body weight can be achieved after Biliopancreatic diversion, but there is a risk of malnutrition and diarrhea. This risk may be reduced by pyloric preservation with duodenalswitch. Loop duodenal switch (Single anastomosis duodeno-ileal bypass with sleeve gastrectomy=SADI-S) is hybrid operation combining moderate intake restriction with moderate malabsorption for treatment of morbid obesity. It is considered a modified version of the original duodenal switch operation in which after the sleeve gastrectomy, the duodenum is anastomosed in end to side, ante colic and isoperistaltic manner to the selected ileal loop with a length of 2 meters from ileocacal valve. Objective: To evaluate the nutritional outcomes as well as to determine weight loss success of Loop duodenal switch Procedure as surgical treatment for morbid obesity on a series of 37 consecutively operated patients in Endocrine surgery Unit, Mansoura University hospital, Mansoura University, Mansoura, Egypt. Patients and methods: A prospective study conducted during the period from July 2010 to January 2013. The mean age was 35.37 ± 7.78years. The mean BMI was 56.25 ± 8.43 kg/m². All patients were subjected to Loop Duodenal Switch after preoperative preparation and laboratory investigations including: Haemoglobin, serum iron, serum ferritin, serum vitamin B12, serum folic acid, serum albumen, serum calcium, serum magnesium, serum phosphorus, serum alkaline phosphatase, serum cupper, serum zinc, serum sodium, serum potassium, serum albumen, Aspartate Aminotransferase (AST), Alanine Transaminase (ALT) and serum bilirubin were followed up over 1 year. Results: Most of the patients had smooth postoperative course with no major morbidity and single mortality. The BMI decreased significantly, from: 56.52 ± 8.47, to 33.21 ± 3.91, with decrease of the amount of food ingested. Both hemoglobin and calcium in Loop DS readilyreturned to within the reference range followingsupplementation with iron and calcium respectively. The mean serum iron,serum ferritin, serum vitamin B12, serum folic acid, , serum calcium, serum magnesium, serum phosphorus,serum Alkaline phosphatase,serum cupper, serum zinc, serum sodium, serum potassium, serum albumen, Aspartate Aminotransferase (AST), Alanine Transaminase (ALT) and serum bilirubinremained within the normal range with no significant nutritional deficiency. Conclusion: LoopDS is not associated with broad nutritional deficiencies and does not appear to pose a threat to nutritional status. It provides excellent weight loss with preservation of good alimentation, even in the super obese. Postoperative supplementation with iron, multivitamins, calcium and vitamin D may be required continuously to prevent nutritional deficiency especially for adults and females in the Child bearing period.