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Management of Malnutrition and Hepatic Impairment After Duodenal Switch.
Lind, Romulo P; Salame, Marita; Kendrick, Michael; Ghanem, Muhammad; Jawad, Muhammad A; Ghanem, Omar M; Teixeira, Andre F.
Afiliação
  • Lind RP; Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, 1st Floor, Orlando, FL, USA. Romulo.lind@orlandohealth.com.
  • Salame M; Department of Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
  • Kendrick M; Department of Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
  • Ghanem M; Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, 1st Floor, Orlando, FL, USA.
  • Jawad MA; Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, 1st Floor, Orlando, FL, USA.
  • Ghanem OM; Department of Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
  • Teixeira AF; Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, 1st Floor, Orlando, FL, USA.
Obes Surg ; 34(2): 602-609, 2024 Feb.
Article em En | MEDLINE | ID: mdl-38177556
ABSTRACT

BACKGROUND:

Malnutrition and liver impairment after duodenal switch (DS) are possible and undesired complications, often conservatively treated. However, in specific cases, surgical revision may be necessary. This study aims to describe outcomes achieved by two bariatric surgery centers and address effectiveness and safety of revisional surgical procedures to resolve these complications.

METHODS:

A retrospective chart review was performed in two bariatric surgery centers from 2008 to 2022. Patients who required revisional surgery to treat malnutrition and/or liver impairment refractory to nutritional and total parenteral nutrition intervention (TPN) after duodenal switch were included. No comparisons were performed due to the descriptive nature of this study.

RESULTS:

Thirteen patients underwent revisional surgery, the mean age was 44.7, the 53.8% were females, and the mean preoperative BMI was 54.7 kg/m2; the mean time between DS and revisional procedure was 26.5 months, and 69.1% of patients were placed on TPN. One patient developed hepatic encephalopathy; one patient presented with ascites, pleural effusion, and renal insufficiency, undergoing reoperation after revisional procedure due to a perforated ileal loop. Mortality rate was 0%; all patients regained weight after the revisional procedure, and the mean total protein and albumin blood levels 12 months after surgery were 6.3 and 3.6 g/dl, respectively.

CONCLUSIONS:

While refractory malnutrition and/or liver failure are rare among patients post-DS, if underdiagnosed and untreated, this can lead to irreversible outcomes and death. All revisional procedures included in this study resulted in improvement of the nutritional status and reversal of liver impairment, with low complication rates.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Obesidade Mórbida / Derivação Gástrica / Desvio Biliopancreático / Desnutrição / Cirurgia Bariátrica / Hepatopatias Tipo de estudo: Etiology_studies / Observational_studies Limite: Adult / Female / Humans / Male Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Obesidade Mórbida / Derivação Gástrica / Desvio Biliopancreático / Desnutrição / Cirurgia Bariátrica / Hepatopatias Tipo de estudo: Etiology_studies / Observational_studies Limite: Adult / Female / Humans / Male Idioma: En Ano de publicação: 2024 Tipo de documento: Article