Is There a Better Design for a Bariatric Procedure? The Case for a Single Anastomosis Duodenal Switch

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Abstract
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.

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