DS long term results - study 

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Background: This report summarizes our 15 year experience with the DS/BPD as a primary procedure on 1,420 patients from 1992-2005.
Methods: Within the last two years, followup of these patients ... is 97 percent.
Results: Survival rate was 92 percent after DS. The risk of death ... was 1.2, almost that of the general population. After a mean of 7.3 years, 92 % of patients with an initial BMI >= 50 obtained a BMI less than 35 and 83 percent of those with an initial BMI greater than 50 obtained a BMI less than 40.  Diabetes was cured i.e. medication was discontinued in 92 percent and medication decreased in the others.  The use of the CPAP apparatus was discontinued in 90 percent. Medication for asthma was decreased in 88 percent and the prevailance of a cardiac risk index > 5 was decreased by 86 percent.

First, notice that it's NOT a 15 year follow up at all.  The "mean followup" was 7 years and the 97 percent follow-up was the last TWO years.  Big difference.

Secondly, if you read in the body of the article, there is no chart about just WHAT the break down of patients by years post op, was.  But we get a clue.  At the 9 year point, only 43 percent of patients had filled out the survey - and we ask again, where WERE the others?

Much of the time, generalizations are made in the article without mentioning EXACT number of patients except for the so called "risk numbers" which are shown on a chart.  These (blood pressure, cholesterol, c-reactive proteins etc) are also very low in AIDS patients and terminal cancer patients yet we cannot say THESE are less at risk.

The low percentage of deaths claimed from "operative death" is, likely in this study as I've seen in others, from the fact that surgeons typically do NOT count the so called "obesity risks" i.e. throwing a P.E. etc as "operative deaths" but only those deaths resulting from leaks i.e. deaths DIRECTLY associated with the surgery or considered thusly.  Deaths from leaks in the anastomosis are few and far between in surgeons who carefully follow up their patients.  However, leaks may not be as uncommon as they would have us believe and can require that the patient, during the healing process have TPN or a feeding tube.

Finally the 97 percent follow up was ONLY in the past TWO years and since the results again don't specify which patients nor are there charts included, we can assume that the results we are seeing in the article are only EARLY results.

The duodenal switch has a very vocal advocacy community (some of whom are suspected to be associated with surgeons in one way or another).  They assiduously hide, side effects and portray this surgery as "safer than the RNY".  However, the number of surgeons who feel the RNY is safer (the overwhelming majority of members of the ASBMS) speaks a lot for how surgeons (who know the ropes) feel, as does the ASBMS proclaiming the RNY as the "gold standard" of weight loss surgery rather than the duodenal switch.

As for the DS/BPD, many questions remain - things like why only short termers are seen on the lists (most less than 5 years post op) and if this surgery IS so great, why is it that it's only a small number of surgeons who perform it and/or advocate it.

The DS/BPD includes a long intestinal bypass about which the ASBMS has written that ANY surgery with an intestinal bypass causing malabsorption can expect at least SOME Of the following complications on the long term:

Any procedure involving malabsorption must be considered at risk to develop at least some of the malabsorptive complications exemplified by JIB. The multiple complications associated with JIB while considerably less severe than those associated with Jejunocolic anastomosis, were sufficiently distressing both to the patient and to the medical attendant to cause the procedure to fall into disrepute.

Listing of jejuno-ileal bypass complications:

Mineral and Electrolyte Imbalance:

• Decreased serum sodium, potassium, magnesium and bicarbonate.
• Osteoporosis and osteomalacia secondary to protein depletion, calcium and vitamin D loss, and acidosis,

Protein Calorie Malnutrition:

• Hair loss, anemia, edema, and vitamin depletion

Cholelithiasis:

Enteric Complications:

• Abdominal distension, irregular diarrhea, increased flatus, pneumatosis intestinalis, colonic pseudo-obstruction, bypass enteropathy, volvulus with mechanical small bowel obstruction.

Extra-intestinal Manifestations:

• Arthritis
• Acute liver failure may occur in the postoperative period, and may lead to death acutely following surgery.
• Liver disease, occurs in at least 30%
• Steatosis, "alcoholic" type hepatitis, cirrhosis, occurs in 5%, progresses to cirrhosis and death in 1-2%
• Erythema Nodosum, non-specific pustular dermatosis
• Weber-Christian Syndrome

Renal Disease:

• Hyperoxaluria, with oxalate stones or interstitial oxalate deposits, immune complex nephritis, "functional" renal failure.

Miscellaneous:

• Peripheral neuropathy, pericarditis. pleuritis, hemolytic anemia, neutropenia, and thrombocytopenia.

This study by Marceau et al, is NOT a long term study and the duodenal switch despite being AROUND for 15 years does not HAVE a real long term study yet.  We must ask "why not?"  Undoubtedly long term studies have been initiated but the results have NOT been shared with the public. Is this because, as Dr. Paul Ernsberger, associate professor of nutrition at Case Western Medical School, has suggested "because it's bad news"?

source: Duodenal Switch Long term results
Picard, Marceau,Biron et al, "Obesity Surgery 17, 1421 - 1430"