Duodenal Switch Combined with Systematic Post-operative Supplementation and Regular Patient Follow-up Results in Good Nutritional Outcomes.

INTRODUCTION: The duodenal switch is the most effective bariatric surgical procedure. Due to technical demands of the surgery and concerns regarding high rates of post-operative nutritional sequelae, many surgeons remain hesitant to adopt this technique. METHODS: Sixty-five patients undergoing duodenal switch surgery at our hospital between 2008 and 2015 were followed up for 5 years. All patients were provided with a thorough post-operative nutritional supplementation regimen. Nutritional deficiencies as evidenced by blood testing, excess body weight loss, and remission rates from type 2 diabetes, hypertension, and dyslipidaemia were studied. RESULTS: The average excess body weight loss 5 years post-operatively was 62% ± 23.03%. Remission rates for type 2 diabetes, hypertension, and dyslipidaemia were 96%, 77% and 84% respectively. Patients achieved good nutritional outcomes. After 5 years, deficiencies in fat-soluble vitamins A and D occurred in 3.3% and 1.6% of patients respectively. The rate of ferritin deficiency at the 5-year post-operative mark was 19.4%. No predictors of nutritional deficiency were identified on univariate analysis. CONCLUSION: Patients undergoing a duodenal switch achieve good long-term excess body weight loss and high obesity-related co-morbidity remission rates. The rates of post-operative nutritional deficiencies in patients who are subjected to a thorough post-operative nutritional supplementation regimen are lower than what was historically expected.

A case of cystic lymphatic malformation mimicking acute appendicitis in an adult patient: a rare diagnostic pitfall.

Abdominal cystic lymphatic malformations are rare pathological entities of uncertain aetiology that usually present in early childhood with indolent abdominal distention. We report the case of a 17-year-old man who presented to our hospital with acute right lower quadrant pain, nausea and anorexia. His blood tests revealed a raised white cell count and elevated inflammatory markers. Clinical examination revealed signs of localised right lower quadrant peritonism. A diagnosis of clinical appendicitis was made, and in keeping with local management protocols, the patient proceeded to theatre for a diagnostic laparoscopy without radiological investigations. Operative findings yielded a normal appendix and a large abdominal cystic malformation. This article highlights the need to keep a broad differential diagnosis when performing surgery on patients with clinically presumed appendicitis and the importance of radiological investigations in clinical decision-making, we also review abdominal cystic lymphatic malformations as a rare diagnostic pitfall.