Single-Anastomosis Procedures in Metabolic Surgery

The most effective long-term treatment for severe obesity is bariatric surgery with improvement or resolution of obesity-related comorbidities. Single-anastomosis procedures including single-anastomosis duodenoileal bypass and one-anastomosis gastric bypass are relatively new procedures that are gaining popularity worldwide. These surgical techniques are perceived to be less complex with a shorter learning curve in comparison to the standard biliopancreatic diversion with duodenal switch and Roux-en-Y gastric bypass; however, long-term outcomes and complications remain controversial. This article aims to review one-anastomosis procedures, evaluate their outcomes, and review potential complications.

Obesity years: clinical variation by age pre/post biliopancreatic diversion/duodenal switch (BPD/DS)

Objective: To identify clinical variation by age, pre/post BPD/DS. Methods: 1673 BPD/DS patients from the Surgical Review Corporation’s BOLD database were analyzed retrospectively by age: <30(177), 30-40(456), 40-50(486), 50-60(407), 60-70(138), >70(9). Data: Demographics, BMI and 33 obesity co-morbidities. Statistics: ANOVA and General Linear Models including pre- and post-operative data modified for binomial distribution of dichotomous variables. Results: Pre-op BMI varied inversely by age and continued through to 12 months post operatively. Gout varied directly and tobacco abuse inversely by age at baseline. The incidence of 12 of the 33 obesity-co-morbidities increased directly with age up to 12 months post operatively. In >60 patients, angina, MS pain, LEE and SUI increased from baseline after undergoing BPD/DS. Conclusion: Despite lower pre-operative and 12-month BMI in older BPD/DS patients, baseline co-morbidities varied directly with age, and post-operative resolution of 12 weight-related problems was inversely proportional to age. Only diabetes resolved better among older patients. These findings suggest the concept of “obesity years”, wherein patients carrying obesity the longest accumulate more co-morbidities and resolve them less.