Laparoscopy in Duodenal Switch: Safe and Halves Length of Stay in a Nationwide Cohort from the Scandinavian Obesity Registry

Scand J Surg. 2017 Sep;106(3):230-234. doi: 10.1177/1457496916673586. Epub 2016 Oct 7.


Background and aims: Unsatisfactory weight loss after gastric bypass or sleeve gastrectomy in super-obese patients (body mass index > 50) is a growing concern. Biliopancreatic diversion with duodenal switch results in greater weight loss, but is technically challenging to perform, especially as a laparoscopic procedure (Lap-DS). The aim of this study was to compare perioperative outcomes of Lap-DS and the corresponding open procedure (O-DS) in Sweden.

Material and methods: The data source was a nationwide cohort from the Scandinavian Obesity Surgery Registry and 317 biliopancreatic diversion with duodenal switch patients (mean body mass index = 56.7 ± 6.6 kg/m2, 38.4 ± 10.2 years, and 57% females) were analyzed. Follow-up at 30 days was complete in 98% of patients.

Results: The 53 Lap-DS patients were younger than the 264 patients undergoing O-DS (35.0 vs 39.1 years, p = 0.01). Operative time was 163 ± 38 min for lap-DS and 150 ± 31 min for O-DS, p = 0.01, with less bleeding in Lap-DS (94 vs 216 mL, p < 0.001). There was one conversion to open surgery. Patients undergoing Lap-DS had a shorter length of stay than O-DS, 3.3 versus 6.6 days, p = 0.02. No significant differences in overall complications within 30 days were seen (12% and 17%, respectively). Interestingly, the two leaks in Lap-DS were located at the entero-enteric anastomosis, while three out of four leaks in O-DS occurred at the top of the gastric tube.

Conclusion: Lap-DS can be performed by dedicated bariatric surgeons as a single-stage procedure. The use of laparoscopic approach halved the length of stay, without increasing the risk for complications significantly. Any difference in long-term weight result is pending.

Keywords: Morbid obesity; bariatric surgery; complications; duodenal switch; laparoscopy; super obesity.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Bariatric Surgery / methods*
  • Duodenum / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Laparoscopy*
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Obesity, Morbid / surgery*
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Registries
  • Sweden
  • Treatment Outcome
  • Weight Loss