Abstract on DS with poor results

July 2, 2001

Dear Group,

I looked through 85 abstracts to find the ones that report poor

results. The purpose of this is not to be alarmist, but to

understand better if there is any reasonable basis for concern

regarding DS.

Interestingly the most negative report comes from Dr. Baltasar in

Spain. His early results were rather poor. I have also included a

later abstract which seemed to have a somewhat different point of

view (but does not give the statistics on mortality/morbidity).

One note: I have found that early studies often have poor results.

There seems to be a steep learning curve on DS. Even the best

surgeons report more complications in there first couple hundred

procedures vs. more recent ones. The surgeons reporting < 200

procedures often have alarmingly high mortality/morbidity rates.

Here is the worst abstract I could find on BPD/DS:

Preliminary results of the duodenal switch.

Obes Surg 1997 Dec;7(6):500-4 (ISSN: 0960-8923)

Baltasar A; del Rio J; Escriva C; Arlandis F; ez R; Serra C

[Find other articles with these Authors]

The Surgical Service, Virgen de los Lirios Hospital, Alcoy, Alicante,

Spain.

BACKGROUND: The duodenal switch (DS), as a modification of the bilio-

pancreatic diversion (BPD), is a 'complex' hybrid operation. METHODS:

Sixty patients were operated on during the last 3 years. RESULTS: Two

patients died early (3.3%); two late deaths occurred at 4 and 7

months, one due to liver failure and the other due to malnutrition

and refeeding syndrome (3.57%); three patients required conversions

(5.3%). The two early deaths and all the patients who required

conversions had a previous vertical banded gastroplasty. Eleven

patients had minor liver abnormalities corrected with medications,

and one patient had severe diarrhea for more than a year. Eleven

female patients have iron deficiency anemia that requires parenteral

supplementation. Mean percent excess weight loss was 86% at 2.5

years. CONCLUSIONS: The DS has been, in our experience, an unsafe

operation with unacceptably high operative and postoperative

mortality. The conversion rate is acceptable. Weight loss, quality of

food intake and life have been excellent. Inadequate follow-up can be

dangerous if patients fail to report for regular visits.

--------------------------------------------------------------

AND NOW HIS 2001 ABSTRACT:

Duodenal switch: an effective therapy for morbid obesity--

intermediate results [in Process Citation]

Obes Surg 2001 Feb;11(1):54-8 (ISSN: 0960-8923)

Baltasar A; Bou R; Bengochea M; Arlandis F; Escriva C; Mir J;

ez R; N [Find other articles with these Authors]

Surgical Service, Virgen de los Lirios Hospital, Alcoy, Alicante,

Spain. abaltasar@....

BACKGROUND: The duodenal switch (DS) is a variant of the

biliopancreatic diversion (BPD), with a vertical subtotal gastrectomy

and pylorus preservation. METHODS: DS was used to treat morbid

obesity in 125 patients, with mean BMI 50, with 65% of the patients

super obese (SO). Patients have been followed for an intermediate

period. RESULTS: The percentage of excess weight loss (%EWL) was >

70% at 1 year, and reached 81.4% at 5 years when 97% of the patients

had a %EWL > 50%. Comorbidities were cured or improved in all

patients. CONCLUSION: DS was very effective for the treatment of the

morbid obesity in the SO patients.

July 2, 2001

It is interesting that Dr. Baltasar has subsequently become a strong

advocate for this procedure above all others. I just recently added his

" latest and greatest " published study ( " Duodenal Switch: an Effective

Therapy for Morbid Obesity-Intermediate Results. " Obes Surg. 2001

Feb;11:54-59) to the DS website:

http://www.duodenalswitch.com/Procedure/baltasar.pdf

This is in .pdf format, so if you don't have the Adobe Acrobat reader

installed in order to open this file, you can get it at the following

URL:

http://www.adobe.com/products/acrobat/readstep2.html

M.

---

in Valrico, FL, age 38

Starting weight 299, now 156

Starting BMI 49.7, now 26.0

Lap DGB/DS by Dr. Rabkin 10-19-99

http://www.duodenalswitch.com

Direct replies: mailto:melanie@...

> Abstract on DS with poor results

>

> Dear Group,

>

> I looked through 85 abstracts to find the ones that report poor

> results. The purpose of this is not to be alarmist, but to

> understand better if there is any reasonable basis for concern

> regarding DS.

>

> Interestingly the most negative report comes from Dr. Baltasar in

> Spain. His early results were rather poor. I have also included a

> later abstract which seemed to have a somewhat different point of

> view (but does not give the statistics on mortality/morbidity).

>

> One note: I have found that early studies often have poor results.

> There seems to be a steep learning curve on DS. Even the best

> surgeons report more complications in there first couple hundred

> procedures vs. more recent ones. The surgeons reporting < 200

> procedures often have alarmingly high mortality/morbidity rates.

>

> Here is the worst abstract I could find on BPD/DS:

>

> Preliminary results of the duodenal switch.

> Obes Surg 1997 Dec;7(6):500-4 (ISSN: 0960-8923)

> Baltasar A; del Rio J; Escriva C; Arlandis F; ez R; Serra C

> [Find other articles with these Authors]

> The Surgical Service, Virgen de los Lirios Hospital, Alcoy, Alicante,

> Spain.

>

> BACKGROUND: The duodenal switch (DS), as a modification of the bilio-

> pancreatic diversion (BPD), is a 'complex' hybrid operation. METHODS:

> Sixty patients were operated on during the last 3 years. RESULTS: Two

> patients died early (3.3%); two late deaths occurred at 4 and 7

> months, one due to liver failure and the other due to malnutrition

> and refeeding syndrome (3.57%); three patients required conversions

> (5.3%). The two early deaths and all the patients who required

> conversions had a previous vertical banded gastroplasty. Eleven

> patients had minor liver abnormalities corrected with medications,

> and one patient had severe diarrhea for more than a year. Eleven

> female patients have iron deficiency anemia that requires parenteral

> supplementation. Mean percent excess weight loss was 86% at 2.5

> years. CONCLUSIONS: The DS has been, in our experience, an unsafe

> operation with unacceptably high operative and postoperative

> mortality. The conversion rate is acceptable. Weight loss, quality of

> food intake and life have been excellent. Inadequate follow-up can be

> dangerous if patients fail to report for regular visits.

>

> --------------------------------------------------------------

>

> AND NOW HIS 2001 ABSTRACT:

>

> Duodenal switch: an effective therapy for morbid obesity--

> intermediate results [in Process Citation]

> Obes Surg 2001 Feb;11(1):54-8 (ISSN: 0960-8923)

> Baltasar A; Bou R; Bengochea M; Arlandis F; Escriva C; Mir J;

> ez R; N [Find other articles with these Authors]

> Surgical Service, Virgen de los Lirios Hospital, Alcoy, Alicante,

> Spain. abaltasar@....

> BACKGROUND: The duodenal switch (DS) is a variant of the

> biliopancreatic diversion (BPD), with a vertical subtotal gastrectomy

> and pylorus preservation. METHODS: DS was used to treat morbid

> obesity in 125 patients, with mean BMI 50, with 65% of the patients

> super obese (SO). Patients have been followed for an intermediate

> period. RESULTS: The percentage of excess weight loss (%EWL) was >

> 70% at 1 year, and reached 81.4% at 5 years when 97% of the patients

> had a %EWL > 50%. Comorbidities were cured or improved in all

> patients. CONCLUSION: DS was very effective for the treatment of the

> morbid obesity in the SO patients.

>

> ----------------------------------------------------------------------

>

July 2, 2001

Did you happen to come across any info from dr. k in delano? I know

he has only been doing this for just over a year, does that mean my

risk of complications is higher?

Ann