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biliopancreatic diversion with duodenal switch

Indications: - morbid obesity; BMI > 40 Procedure: 1) the greater curvature of the stomach is resected 2) the 1st segment of the duodenum is divided 3) the proximal duodenum & 1/2 of the small intestine is excluded from the flow of digestive material 4) the small intestine is divided 300 cm above the ileocecal junction, & the distal end anastomosed to the first portion of the duodenum 5) the distal end of the excluded segment is anastomosed to the ileum 50-100 cm proximal to the ileocecal junction; the proximal end is sealed; pancreatic & biliary secretions flow through this segment into the ileum Complications: - adverse effects in 80% of patients [3] - malnutrition-related events - night blindness (vitamin A deficiency) - severe iron deficiency - protein calorie malnutrition Notes: - greater weight loss than gastric bypass (74 vs 51 kg) [3] - BMI decrease of 22 vs 14 [3] - greater reduction in LDL cholesterol than gastric bypass - more adverse events than gastric bypass (62 vs 32%) [1,3] - more hospital admission (60% vs 30%) - additional surgical procedures (45% vs 10%)

General

bariatric surgery

References

  1. Brolin RE Bariatric surgery and long-term control of morbid obesity. JAMA. 2002 Dec 11;288(22):2793-6. Review. No abstract available. PMID: 12472304
  2. Sovik TT et al Weight Loss, Cardiovascular Risk Factors, and Quality of Life After Gastric Bypass and Duodenal Switch: A Randomized Trial Annals of Internal Medicine, September 6, 2011 155(5)281-291 PMID: 21893621 http://www.annals.org/content/155/5/281.abstract
  3. Risstad H et al Five-Year Outcomes After Laparoscopic Gastric Bypass and Laparoscopic Duodenal Switch in Patients With Body Mass Index of 50 to 60A Randomized Clinical Trial. JAMA Surg. Published online February 04, 2015 PMID: 25650964 http://archsurg.jamanetwork.com/article.aspx?articleid=2107252 - Varban OA, Dimick JB Weighing the Risks and Benefits of Bariatric Surgery. Choose Your Own Adventure. JAMA Surg. Published online February 04, 2015 PMID: 25650547 http://archsurg.jamanetwork.com/article.aspx?articleid=2107249