EF = ejection fraction? Losing weight will increase it? But you can't have WLS until your EF is higher? Ugh - is this possibly a situation where a 2-part DS might be best, perhaps the intestinal rearrangement first? That would cause some weight loss, as well as almost certainly address your type II diabetes.
I don't have the full article, but Marceau et al. 2014 published a study in which they showed the intestinal part of the DS (without the sleeve) as a staged procedure was preferable to doing the sleeve first:
https://www.ncbi.nlm.nih.gov/pubmed/24839191
Obes Surg. 2014 Nov;24(11):1843-9. doi: 10.1007/s11695-014-1284-0.
Biliopancreatic diversion-duodenal switch: independent contributions of sleeve resection and duodenal exclusion.
Marceau P1,
Biron S,
Marceau S,
Hould FS,
Lebel S,
Lescelleur O,
Biertho L,
Kral JG.
Author information
1
Department of Bariatric Surgery, Quebec, Laval Hospital, IUCPQ, University Institute Cardiology and Pneumology, Laval University 2725, Chemin Ste-Foy, Québec, QC, G1V 4G5, Canada,
[email protected].
Abstract
BACKGROUND:
The choice of first-stage operation in bilio-pancreatic diversion with duodenal switch (BPD-DS) is controversial. There are no published long-term comparisons of one- and two-stage BPD-DS outcomes.
METHODS:
During 2001-2009, among 1,762 patients scheduled for BPD-DS 48 had duodenal switch (DS) and 53 sleeve gastrectomy (SG) as first-stage procedures. We compared prospectively updated outcomes of 42 DS (100 % open) and 49 SG (88 % laparoscopic), 13 of whom completed their second stage, to a control group of 91 patients with open one-stage BPD-DS.
RESULTS:
One-year mean percent excess weight loss (%EWL) was greater after SG than DS (47 ± 19 vs. 39 ± 13 SD; p = 0.01) with earlier nadir (16 ± 10 vs. 45 ± 30 months; p < 0.0001) but more rapid significant weight regain. After 5 years, %EWL was 12 ± 35 for 9 SG, 45 ± 19 for 30 DS (p < 0.0006), and 70 ± 18 for the first-stage BPD-DS (p < 0.0001). Weight loss was less after two- than one-stage procedures (p < 0.02). Comorbidities improved progressively between SG, DS and BPD-DS (p < 0.001 for trend). HbA1C decreased by 10, 19, and 31 %, respectively (p < 0.0001). Dyslipidemia was cured in 41, 82, and 100 %, respectively. Systolic and diastolic blood pressure decreased only after DS (12 %; p < 0.0002). Patient satisfaction was similar for SG and DS but greater after BPD-DS overall (p = 0.04).
CONCLUSIONS:
SG and DS independently contribute to beneficial metabolic outcomes after BPD-DS.
Long-term weight loss and correction of metabolic abnormalities were better after DS favoring its use as first stage in BPD-DS; one-stage BPD-DS outcomes were superior to two-staged.