Duodenal Switch = better weight loss + more adverse events?

I am sure and it is taking some business away.....

It's interesting that they quoted so extensively from someone not even involved with the study.  Obviously because he was willing to be more quotable and controversial, where another scientist would say things like "needs more follow up," or "interesting implications for futher research."

It was a small sample size.  But it was also the first one I've read that assigned the study groups randomly.  So I wonder if part of the reason for the higher DS complications with malnutrition and protein deficiences was due to the participants not really being ready for the extensive vitamin regimen that DS requires?

Shoot, I have to add an extra multivitamin and calcium pill after my sleeve surgery, and would have a hard time if I had to do much more than that.  The taking pills 5-6 times/day, 15-20 pillls/day that I have seen many DS'ers doing would be overwhelming to me.  Without a good bit of mental preparation, education and dedication, I can see how study participants would falter.  I wonder how closely their compliance was tracked?  And if they were compliant, did they still have complications?

All that said, I'm not really surprised that the rate of complications for the DS was higher since it is a more extensive re-routing.  It is a pretty dramatic thing to do to the body.

And to whoever mentioned that quality of life should count for something - I agree.  But that is not an easy variable to measure.

Yeah, that 'randomly assigned' bugged me, too---what sort of patient is willing to accept random assignment of something so life-altering as WLS? I suspect they gave all the ptaients the exactly same post-op instructions, and that doesn'tfly.

I also noted that the DS patients were larger, which usually translates into "sicker", too.

If the DS patients were larger, then I doubt they really were randomly assigned.

It's a very standard research technique to do random assignment into groups and one criticism of most bariatric studies is that the patients are self-selected. Of course, the reason is that it's really unethical to assign someone a surgery type!

So in some ways, it's good that they were randomly assigned because that can weed-out confounding factors. But in another way it's bad because this isn't testing some new medicine for 6 months. This is making a major decision that is going to dramatically impact a person's life forever for them.

60 patients? Not a large enough study. Plus there are so many things that are attributed to DS that also is a problem for RNYers that I'm gonna stick my fingers in my ears and nah, nah, nah I can't hear you.

Ok, you little troublemaker.

No where does it mention what post op protocols were used for the DSers. There was no acknowledgment at all that the nutritional requirements are different for the DS. IF all groups were treated equally, it is no small surprise that the DSers would suffer malnutrition if directed to follow RnY eating and vitamin regimens.

No vomiting, abdominal pain, diarrhea, or obstructions in the RnY group?  Really? All of ya'll have been going to the wrong surgeon.

And Livingston, the idiot doesn't even seem to know that the improvement/resolution of diabetes has nothing to do with weight loss as it typically begins immediately post op.

I'm also curious where he found a group of "healthy" super morbidly obese people with BMIs over 50. They could only have been young adults whose bodies are not yet demonstrating the damage that is being done. By its very definition "morbid obesity" means fat that is killing you.

And night blindness caused by vitamin A deficiency, reversible by taking A? Obviously the subject wasn't on an adequate vitamin protocol, for crying out loud.

I could go on, but this was written by an ignorant quack. It belongs in Weekly World News right next to the latest article about Bat Boy.

 "No vomiting, abdominal pain, diarrhea, or obstructions in the RnY group?  Really? All of ya'll have been going to the wrong surgeon."

They been lyin'.

"Healthy" probably isn't the best word, but I had a BMI of 52 and I had no health issues....no HBP, no diabetes, no sleep apnea, perfect cholesterol--I passed all the tests....I was just SMO.

However..........family history on both sides was littered with all the obesity related diseases....it was just a matter of time.  My surgeon said that the only thing that kept them at bay was likely my continued physical activity.  I exercised regularly--even at 325 lbs.

We all knew there were possible health risks when we signed on for our surgery.  We also (most of us) accepted that we would have a very specific nutritional protocol that must be followed for life to ensure the greatest success. 

I know I made the right decision for ME, regardless of what some study says.  Even if my life expectancy is not improved, the quality of the life I have now is LIVING, where before I was just EXISTING. 

I'll take 15 minutes of living over 15 years of existing hands down!

This article points out the exact reason why a study such as this would never take place in the United States. It is MALPRACTICE plain and simple.

Let me preface my comments by stating I am a duodenal switch patient. I am also a board-certified physician (not a surgeon) and a major proponent of the duodenal switch.

There are major flaws with this study:

1. The length of the study is inadequate and leaves open-ended statement about not knowing what will happen over time. There are other studies in existence already that have results spanning 15+ years.

2. The participating surgeons admit they are inexperienced DS surgeons; therefore, intraoperative risks as well as postoperative complications are more likely for patients in the DS arm of the study.

3. The malabsorptions for DS vs RNY are completely different. The vitamin supplementation prescribed could have permanently harmed a DS patient because it violates standard of care. Since DS patients malabsorb 80% of the fat they consume, the risk of fat-soluble vitamin deficiencies (A-D-E-K) is substantial. Not only do the authors not supplement at the proper levels, but they do not indicate which form their vitamin supplements were dispensed. If those vitamins were dispensed in a oil base, then the patients were getting very little supplementation at all. Finally, any physician should check labs on bariatric patients frequently and adjust their supplements based upon those results. These patients were placed on an inadequate regimen to begin with and no such adjustments were made. Any permanent damage to patients in the DS arm as a result of this negligence should be grounds for a malpractice lawsuit.

4. The study clearly shows more weight loss with DS vs. RNY; furthermore, it shows more improvement in cardiovascular risk factors. It also clearly states that patients had equal quality of life regardless of procedure, yet it deemed DS inferior due to a short form that patients completed showing 1 out of 8 subjective symptoms ("bodily pain") appeared to be more improved in RNY patients.

5. The only reason malnutrition only showed up in the DS arm is the ignorance on the researchers' behalf in regards to supplementation needs to begin with.

Dr. Livingston is not a DS surgeon. His bias toward DS is understandable. Where are the viewpoints from a surgeon who does perform DS? There is no balance in this article and it is serves as a major disservice to the DS procedure.

DS is referred to as the platinum standard of weight loss surgery. I treat my obese patients naturally, medically, and am quick to refer for bariatric surgery when necessary.  I have nine patients in my own practice undergoing DS in August and September of this year alone. My decision to recommend DS is based on data collected since this procedure was first offered in the US in 1988.

DS cured my diabetes. My preoperative weight was 342 lbs and my present weight is 164 lbs. I am normal weight and take no prescription medications. My labs are perfect because my supplementation regimen is adjusted based upon my labs which are done on a scheduled basis. My diabetes was completely resolved within two weeks of my surgery even though I still weighed 330 lbs. This alone indicates that my diabetes was not obesity-related, but also based on metabolic and hormonal abnormalities as well that DS corrected. I am not slowly dying; on the contrary, I am living life to the fullest for the first time in a long time.

My diabetes, hypertension, hyperlipidemia, and obstructive sleep apnea were killing me. I no longer suffer from any of those comorbid conditions. Conventional diet and exercise failed in my case. I did not "LET" myself go preoperatively out of choice. My obesity was not related to an eating disorder or an emotional disorder. There is more to obesity than overeating and there is more to weight loss than "eat less and exercise more". Type 2 diabetes is highly prevalent in my family (over 80% in my immediate family alone). I would be on an insulin pump by now with a dramatically decreased life expectancy if not for DS. Suggesting that DS no longer performed is the equivalent of signing an early death certificate for me.

This article should be retracted in its entirety. To suggest a procedure that provides a 99+% cure for type 2 diabetes be discontinued because of blatant physician negligence/incompetence in the referenced study is completely unfounded. DS should be making headline news for its scientifically-proven benefits.

Having DS is one of the best decisions I have ever made. I will continue to recommend it to my patients. I hope others will do their own research regarding this remarkable procedure rather than accept this article at face value.

 Thank you for bringing your brains over.  I was just about to post your blog post.