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Research Into Biliopancreatic Diversion/Duodenal Switch Gastric Bypass

Study of biliopancreatic duodenal switch open, laparoscopic bypass
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Research Into Biliopancreatic Diversion/
Duodenal Switch Gastric Bypass Procedure

Weight Loss Benefits

The basic principle of the biliopancreatic diversion/ duodenal switch (BPD/DS) procedure is similar to that of the biliopancreatic bypass. Scopinaro et al., who developed the procedure, report the largest experience with biliopancreatic bypass. The procedure, in a series of 2,241 patients operated on during a 21-year period, caused a mean permanent reduction of approximately 75% of the initial excess weight. The authors report that during the first 3 to 4 months after the surgery, patients have decreased appetites related to the dumping syndrome. Scopinaro, Marinari, and Camerini reported similar early results with the laparoscopic technique.

Open Surgery Procedure

The duodenum is divided between the stomach and the bile ducts, diverting pancreatic juice and bile. The duodenal stump is then closed. Ninety percent of the stomach is removed. The small intestine is divided. Using this separated section of small intestine, the surgeon makes a new connection to the open end of the duodenum. The remaining end of the small intestine is re-attached approximately 30 in. from the colon. This biliopancreatic segment now carries the digestive enzymes and bile. Food and digestive juices mix in the final short 30-in. section of the intestine.

Laparoscopic Procedure

Baltasar et al. and Feng and Gagner described a laparoscopic variant of the biliopancreatic bypass, the duodenal switch procedure. Instead of performing a distal gastrectomy, the surgeon performs a sleeve gastrectomy along the vertical axis of the stomach, preserving the pylorus and initial segment of the duodenum, which is then anastomosed to a segment of the ileum, similar to the above procedure, to create the alimentary segment. Preservation of the pyloric sphincter is designed to be more physiological. The sleeve gastrectomy decreases the volume of the stomach and also decreases the parietal cell mass, with the intent of decreasing the incidence of ulcers at the duodeno-ileal anastomosis. However, the basic principle of the procedure is similar to that of the biliopancreatic bypass, i.e. it produces selective malabsorption by limiting food digestion and absorption to a short, common ileal segment. The potential for metabolic complications exists with this procedure. Patients undergoing the duodenal switch procedure require long-term medical follow-up and regular monitoring of fat-soluble vitamins, vitamin B12, iron and calcium.

Biliopancreatic Versus Duodenal Switch

Marceau et al. reported on 465 patients with a duodenal switch procedure compared with 252 patients who underwent the biliopancreatic bypass. In addition to the preservation of the duodenum, the common segment was elongated to 100 cm. The authors noted similar weight loss in the two groups. In the duodenal switch group, a lower incidence of metabolic abnormalities such as protein malnutrition was noted, which prompted reversal of the procedure in 1.7% of those undergoing biliopancreatic bypass vs only 0.1% after the duodenal switch procedure. The excess weight loss varied between 70% and 90%, depending on the length of the common segment and alimentary limb. The biliopancreatic diversion with duodenal switch combines a sleeve gastrectomy with a duodeno-ileal switch to achieve maximum weight loss. Consistent excess weight loss of between 70% and 80% is achieved, with acceptable decreased long-term nutritional complications. With a higher entry weight, the super-obese patient (BMI >50 kg/m2) benefits the greatest from a procedure that produces a higher mean excess weight loss. The laparoscopic approach to this procedure has successfully created a surgical technique with optimum benefit and minimum morbidity, especially in the super-obese patient.

Gastric Bypass
Vertical Banded Gastroplasty

Sources:
Scopinaro N, Adami GF, Marinari GM, Gianetta E, Traverso E, Friedman D, Camerini G, Baschieri G, Simonelli A (1998) Biliopancreatic diversion. World J Surg 22:936–946
Scopinaro N, Marinari GM, Camerini G (2002) Laparoscopic standard biliopancreatic diversion: technique and preliminary results. Obes Surg 12:362–365
Baltasar A, Bou R, Miro J, Bengochea M, Serra C, Perez N (2002) Laparoscopic biliopancreatic diversion with duodenal switch: technique and initial experience. Obes Surg 12:245–248
Feng JJ, Gagner M (2002) Laparoscopic biliopancreatic diversion with duodenal switch. Semin Laparosc Surg 9:125–129
Marceau P, Hould FS, Simard S, Lebel S, Bourque RA, Potvin M, Biron S (1998) Biliopancreatic diversion with duodenal switch. World J Surg 22:947–954
Kim WW, Gagner M, Kini S, Inabnet WB, Quinn T, Herron D, Pomp A (2003) Laparoscopic vs open biliopancreatic diversion with duodenal switch: a comparative study. J Gastrointest Surg 7:552–557
International Federation For The Surgery of Obesity

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Laparoscopic or open bariatric surgery, such as gastric banding or bypass is not an easy solution to morbid obesity and weight loss. It is a serious surgical procedure, involving health risks. To produce lasting weight loss it requires a long-term patient commitment to eating a healthy diet and following a regular program of physical exercise. Life-long use of nutritional supplements may also be necessary. So, before deciding, discuss your options fully with your doctor. © 2003-2017 Bariatric-Surgery.Info - Terms - Contact - Information - Resources