Background

Most surgeons who perform single-anastomosis duodenal switches use a pre-determined length for the common channel without measuring total bowel length (TBL). The purpose of this study was to determine if using TBL measurements to calculate the optimal common channel length would reduce reoperations and complication rates.

Methods

A retrospective review was conducted to identify all patients who underwent a single anastomosis duodenal switch at our institution between September 2017 and February 2022. In April 2021, we began performing TBL measurements in all patients with 40% of the TBL used as the length for the common channel. Outcomes pre-TBL and post-TBL measurements were analyzed.

Results

A total of 119 patients (59 pre-TBL measure; 60 post-TBL measure) were included in this study. Preoperative characteristics were similar between the groups. The post-TBL measure group had a significantly longer common channel length than the pre-TBL measure group (309.8 cm vs 268.6 cm, p<0.001). The pre-TBL measure group had a significantly higher rate of reoperations (23.7% vs 1.7%, p<0.001) and long-term complications (29.3% vs 3.3%, p<0.001). The mean time for reoperation in the pre-TBL measure group was 13.7±7 months. Patients in the post-TBL measure group had significantly higher postoperative albumin levels at 3 months (4.2 g/dL vs 3.5 g/dL, p<0.001) 6 months (4.2 g/dL vs 3.7 g/dL, p<0.001), and 12 months (4.2 g/dL vs 3.8 g/dL, p=0.023) (table 1).

Conclusions

Using TBL measurements to calculate optimal common channel length significantly reduces reoperations and long-term complication rates after single anastomosis duodenal switches.