Is There a Better Design for a Bariatric Procedure? The Case for a Single Anastomosis Duodenal Switch
The majority of bariatric surgical stapling procedure concepts were developed prior to the understanding of obesity as an energy storage disease. Conventional treatments did not consider the impact of macronutrients on hormones and glucose variability. Current recommendations suggest diets low in glycemic load, with moderate protein and unsaturated fat. Roux-en-Y gastric bypass promotes glucose variability which can be harmful for health and encourage weight regain. Classic duodenal switch with short common channels may prevent absorption of measurable fat-soluble vitamins and frequently untested essential fatty acids. The purpose of this review is to discuss these factors and explain why single anastomosis duodenal switch reduces glucose variability, allows for absorption of critical fats and fat-soluble vitamins, and has potential to offer better weight loss and metabolic outcomes.
KeywordsGlucose variability Single anastomosis SADI DS SIPS Bariatric RYGB Duodenal switch
Compliance with Ethical Standards
Conflict of Interest
Mitchell Roslin MD, the corresponding author, reports grants from Medtronic, during the conduct of the study, and personal fees and non-financial support from Ethicon, outside the submitted work. Mitchell Roslin MD is the principle investigator of the US SIPS trial and provides educational content and courses on behalf of Ethicon.
Bugra Tugertimur MD has no conflicts of interest to declare.
Sharon Zarabi RD has no conflicts of interest to declare.
Daniel Cottam MD has been provided grants and has given lectures on behalf of Medtronic.
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