Endocrine Abstracts

Introduction: Biliopancreatic diversion with duodenal switch (BPD DS) is the most effective metabolic surgery, but accounts for < 1% of metabolic surgeries performed Worldwide due to its technical complexity and severe malabsorption. Its loop modification, single anastomosis duodenoileal bypass with sleeve (SADI S) with 200–250 cm common channel, reduces malabsorption to some extent. But a 250 cm common channel appears to be shorter for Indian patients. ‘Sleeve gastrectomy with loop duodenal switch (Fixed common channel) – SG LDS (FCC)’ is a further modification of SADI S, with a common channel length of 300 or 350 cm to reduce malabsorption further, without compromising on metabolic efficacy.

Material and Methods: Between November 2014 and December 2019, 146 patients underwent SG LDS (FCC). Outcomes of these patients were retrospectively analyzed from prospectively entered database.

Results: Out of 157 patients, 22, 13, 101 and 10 had common channel of 250, 300, 350 and varied lengths. Mean BMI was 45.29 ± 7.58 kg/m². 50.96% patients were suffering from type 2 diabetes. Mean excess weight losswith 25 BMI cut off point was 74.04%, 99.75% and diabetes remission with HbA1C < 6 cut off, was 80.6%, 90.9% at 6 months and 1 year intervals respectively, Protein malnutrition with albumin levels < 3 g/dl, was 44.4% and 8.6% with 250 and 350 cm common channel length respectively. 30 day mortality was zero.

Conclusions: SG LDS (FCC) appears to be a very effective and safe surgery. Maintained long term weight loss and Diabetes remission were positively significant. Malabsorption risk is greatly reduced when common channel length is increased to 300–350 cm or more.

Key words: Single anastomosis duodenoileal bypass, loop duodenal switch, fixed common channel, SADI S).