Advertisement

Laparoscopic Duodenal Switch

  • Michel Gagner
Chapter

Abstract

Duodenal switch offers one of the best long-term controls of obesity-related diseases such as type-2 diabetes and is associated with one of the lowest risks of weight regain long-term. It should be part of surgeons’ armamentarium, particularly for the management of weight regain following sleeve gastrectomy. Like any advanced surgical procedure, there is a learning curve associated with laparoscopic DS, but standardization of the different surgical steps allows keeping complication rates low. The use of a hand-sewn anastomosis allows keeping the risk of anastomotic leak to the lowest. In case of intraoperative difficulties, the procedure can be aborted to a stand-alone sleeve gastrectomy, and a duodenal switch can be performed 18 months to several years after the initial surgery, without losing its efficacy.

Keywords

Morbid obesity Metabolic syndrome Type II diabetes Roux-en-Y gastric bypass Sleeve gastrectomy Biliopancreatic diversion Duodenal switch 

Notes

Conflicts of Interest

The authors have no conflicts of interest to declare.

References

  1. 1.
    Scopinaro N, Gianetta E, Civalleri D, et al. Bilio-pancreatic bypass for obesity: II. Initial experience in man. Br J Surg. 1979;66(9):618–20.PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    DeMeester TR, Fuchs K, Ball C, Albertucci M, Smyrk TC, Marcus J. Experimental and clinical results with proximal end-to-end duodenojejunostomy for pathologic duodenogastric reflux. Ann Surg. 1987;206(4):414–26.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Marceau P, Biron S, Bourque RA, Potvin M, Hould FS, Simard S. Biliopancreatic diversion with a new type of gastrectomy. Obes Surg. 1993;3(1):29–35.PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Hess DS, Hess DW. Biliopancreatic diversion with a duodenal switch. Obes Surg. 1998;8:267–82.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Ren CJ, Patterson E, Gagner M. Laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients. Obes Surg. 2000;10:514–23.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    DeCsepel J, Burpee S, Jossart G, Andrei V, Murakami Y, Benavides S, Gagner M. Laparoscopic biliopancreatic diversion with a duodenal switch for morbid obesity: a feasibility study in pigs. J Laparoendosc Adv Surg Tech A. 2001;11(2):79–83.CrossRefGoogle Scholar
  7. 7.
    Gagner M, Matteotti R. Laparoscopic biliopancreatic diversion with duodenal switch. Surg Clin North Am. 2005;85(1):141–9.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Feng JJ, Gagner M. Laparoscopic biliopancreatic diversion with duodenal switch. Semin Laparosc Surg. 2002;9(2):125–9.PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Sánchez-Pernaute A, Rubio MÁ, Cabrerizo L, Ramos-Levi A, Pérez-Aguirre E, Torres A. Single-anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) for obese diabetic patients. Surg Obes Relat Dis. 2015;11(5):1092–8.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    O’Brien PE, Hindle A, Brennan L, Skinner S, Burton P, Smith A, Crosthwaite G, Brown W. Long-term outcomes after bariatric surgery: a systematic review and meta-analysis of weight loss at 10 or more years for all bariatric procedures and a single-centre review of 20-year outcomes after adjustable gastric banding. Obes Surg. 2019;29(1):3–14.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Sovik TT, Taha O, Aasheim ET, et al. Randomized clinical trial of laparoscopic gastric bypass versus laparoscopic duodenal switch for superobesity. Br J Surg. 2010;97:160–6.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Risstad H, Søvik TT, Engström M, Aasheim ET, Fagerland MW, Olsén MF, Kristinsson JA, le Roux CW, Bøhmer T, Birkeland KI, Mala T, Olbers T. Five-year outcomes after laparoscopic gastric bypass and laparoscopic duodenal switch in patients with body mass index of 50 to 60: a randomized clinical trial. JAMA Surg. 2015;150(4):352–61.PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Biertho L, Biron S, Hould FS, et al. Is biliopancreatic diversion with duodenal switch indicated for patients with body mass index <50 kg/m2? Surg Obes Relat Dis. 2010;6:508–14.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Anthone GJ, Lord RVN, DeMeester TR, Crookes PF. The duodenal switch operation for the treatment of morbid obesity. Ann Surg. 2003;238:618–27.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Strain GW, Gagner M, Inabnet B, et al. Comparison of effects of gastric bypass and biliopancreatic diversion with duodenal switch on weight loss and body composition 1-2 years after surgery. Surg Obes Relat Dis. 2007;3:31–6.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Marceau P, Biron S, Hould FS, et al. Duodenal switch improved standard biliopancreatic diversion: a retrospective study. Surg Obes Relat Dis. 2009;5:43–7.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Topart P, Becouarn G, Salle A. Five-year follow-up after biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis. 2011;43:205–8.Google Scholar
  19. 19.
    Crea N, Pata G, Di Betta E, et al. Long-term results of biliopancreatic diversion with or without gastric preservation for morbid obesity. Obes Surg. 2011;21:139–45.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Papadia FS, Adami GF, Marinari GM, et al. Bariatric surgery in adolescents: a long-term follow-up study. Surg Obes Relat Dis. 2007;3:465–8.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Nelson D, Beekley A, Carter P, et al. Early results after introduction of biliopancreatic diversion/duodenal switch at a military bariatric center. An J Surg. 2011;201:678–84.CrossRefGoogle Scholar
  22. 22.
    Vage V, Nilsen R, Berstad A, et al. Predictors for remission of major components of the metabolic syndrome after biliopancreatic diversion with duodenal switch (BPDDS). Obes Surg. 2013;23:80–6.PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;266:1577–85.CrossRefGoogle Scholar
  24. 24.
    Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Nanni G, Castagneto M, Bornstein S, Rubino F. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2015;386(9997):964–73.PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Iaconelli A, Panuzi S, De Gatetano A, et al. Effects of bilio-pancreatic diversion on diabetic complications: a 10-year follow-up. Diabetes Care. 2011;34:561–7.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Tsoli M, Chronaiou A, Kehagias I, et al. Hormone changes and diabetes resolution after biliopancreatic diversion and laparoscopic sleeve gastrectomy: a comparative prospective study. Surg Obes Relat Dis. 2013;9(5):667–77.PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Strain GW, Torghabeh MH, Gagner M, Ebel F, Dakin GF, Abelson JS, Connolly D, Pomp A. The impact of biliopancreatic diversion with duodenal switch (BPD/DS) over 9 years. Obes Surg. 2017;27(3):787–94.PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery systematic review and meta-analysis. Am J Med. 2009;122:248–56.PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Dixon JB, Zimmer P, Alberti KG, et al. Bariatric surgery: an IDF statement for obese type 2 diabetes. J Diabetes. 2011;3:261–4.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Rubino F, Nathan DM, Eckel RH, Schauer PR, Alberti KG, Zimmet PZ, Del Prato S, Ji L, Sadikot SM, Herman WH, Amiel SA, Kaplan LM, Taroncher-Oldenburg G, Cummings DE, Delegates of the 2nd Diabetes Surgery Summit. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Obes Surg. 2017;27(1):2–21.PubMedCrossRefPubMedCentralGoogle Scholar
  31. 31.
    Astiarraga B, Gastaldelli A, Muscelli E, et al. Biliopancreatic diversion in nonobese patients with type 2 diabetes: impact and mechanisms. J Clin Endocrinol Metab. 2013;98(7):2765–73.PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Pata G, Crea N, Di Betta E, et al. Biliopancreatic diversion with transient gastroplasty and duodenal switch: long-term results of a multicentric study. Surgery. 2013;153:413–22.PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Buchwald H, Oien D. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23:427–36.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Ponce J, Nguyen NT, Hutter M, Sudan R, Morton JM. American Society for Metabolic and Bariatric Surgery estimation of bariatric surgery procedures in the United States, 2011–2014. Surg Obes Relat Dis. 2015;11(6):1199–200.PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Kim WW, Gagner M, Kini S, Inabnet W, Quinn T, Herron D, Pomp A. Laparoscopic vs open biliopancreatic diversion with duodenal switch: a comparative study. J Gastrointest Surg. 2003;7(4):552–7.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Biertho L, Lebel S, Marceau S, Hould FS, Lescelleur O, Moustarah F, Simard S, Biron S, Marceau P. Perioperative complications in a consecutive series of 1000 duodenal switches. Surg Obes Relat Dis. 2013;9(1):63–8.PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Nguyen NT, Paya M, Stevens M, et al. The relationship between hospital volume and outcome in bariatric surgery at academic medical centers. Ann Surg. 2004;240:586–93.PubMedPubMedCentralGoogle Scholar
  38. 38.
    Ballantyne GH, Belsley S, Stephens D, et al. Bariatric surgery: low mortality at a high-volume center. Obes Surg. 2008;18:660667.CrossRefGoogle Scholar
  39. 39.
    English WJ, DeMaria EJ, Brethauer SA, Mattar SG, Rosenthal RJ, Morton JM. American Society for Metabolic and Bariatric Surgery estimation of metabolic and bariatric procedures performed in the United States in 2016. Surg Obes Relat Dis. 2018;14(3):259–26.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Buchwald H, Estok R, Fahrbach K, Banel D, Sledge I. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery. 2007;142(4):621–32; discussion 632–5PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Demaria EJ, Winegar DA, Pate VW, et al. Postoperative outcomes of metabolic surgery to treat diabetes from sites participating in the ASMBS bariatric surgery center of excellence program as reported in the bariatric outcomes longitudinal database. Ann Surg. 2010;252:559–66.PubMedPubMedCentralGoogle Scholar
  42. 42.
    Hamoui N, Chock B, Anthone GJ, Crookes PF. Revision of the duodenal switch: indications, technique and outcomes. J Am Coll Surg. 2007;204:603–8.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Gagner M, Rogula T. Laparoscopic Reoperative sleeve gastrectomy for poor weight loss after biliopancreatic diversion with duodenal switch. Obes Surg. 2003;13:649–54.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Sekhar N, Gagner M. Complications of laparoscopic biliopancreatic diversion with duodenal switch. Curr Surg. 2003;60(3):279–80.PubMedCrossRefPubMedCentralGoogle Scholar
  45. 45.
    Faintuch J, Matsuda M, Emilia M, et al. Severe protein-calorie malnutrition after bariatric procedures. Obes Surg. 2004;14:175–81.PubMedCrossRefPubMedCentralGoogle Scholar
  46. 46.
    Aills L, Blankenship J, Buffington C, et al. ASMBS allied health nutritional guidelines for the surgical weight loss patient. Surg Obes Relat Dis. 2008;4:S73–S108.PubMedCrossRefPubMedCentralGoogle Scholar
  47. 47.
    Marceau P, Biron S, Hould FS, et al. Duodenal switch: long-term results. Obes Surg. 2007;17:1421–30.PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Aasheim ET, Bjorkman S, Sovik TT, et al. Vitamin status after bariatric surgery: a randomized study of gastric bypass and duodenal switch. Am J Clin Nutr. 2009;90(1):15–22.PubMedCrossRefPubMedCentralGoogle Scholar
  49. 49.
    Slater GH, Ren CJ, Siegel N, et al. Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointest Surg. 2004;8:48–55.PubMedCrossRefPubMedCentralGoogle Scholar
  50. 50.
    Balsa JA, Botella-Carretero JI, Peromingo R, et al. Chronic increase of bone turnover markers after biliopancreatic diversion is related to secondary hyperparathyroidism and weight loss. Relation with bone mineral density. Obes Surg. 2010;20:468–73.PubMedCrossRefPubMedCentralGoogle Scholar
  51. 51.
    Sinha N, Shieh A, Stein EM, Strain G, Schulman A, Pomp A, Gagner M, Dakin G, Christos P, Bockman RS. Increased PTH and 1.25(OH)(2)D levels associated with increased markers of bone turnover following bariatric surgery. Obesity (Silver Spring). 2011;19(12):2388–93.CrossRefGoogle Scholar
  52. 52.
    Marceau P, Biron S, Lebel S, et al. Does bone change after biliopancreatic diversion? J Gastrointest Surg. 2002;6:690–8.PubMedCrossRefPubMedCentralGoogle Scholar
  53. 53.
    Primavera A, Brusa G, Novello P, et al. Wernicke-Korsakoff encephalopathy following biliopancreatic diversion. Obes Surg. 1993;3:175–7.PubMedCrossRefPubMedCentralGoogle Scholar
  54. 54.
    Aasheim ET, Sovik TT, Bakke EF. Night blindness after duodenal switch. Surg Obes Relat Dis. 2008;4:685–6.PubMedCrossRefPubMedCentralGoogle Scholar
  55. 55.
    Aasheim ET, Hofso D, Hjelmesaeth J, Sandbu R. Peripheral neuropathy and severe malnutrition following duodenal switch. Obes Surg. 2008;18:1640–3.PubMedCrossRefPubMedCentralGoogle Scholar
  56. 56.
    Aasheim ET. Wernicke encephalopathy after bariatric surgery: a systematic review. Ann Surg. 2008;248:714–20.PubMedPubMedCentralGoogle Scholar
  57. 57.
    Stroh C, Weiher C, Hohmann U, et al. Vitamin a deficiency (VAD) after a duodenal switch procedure: a case report. Obes Surg. 2010;20:397–400.PubMedCrossRefPubMedCentralGoogle Scholar
  58. 58.
    Strain GW, Torghabeh MH, Gagner M, Ebel F, Dakin GF, Connolly D, Goldenberg E, Pomp A. Nutrient status 9 years after biliopancreatic diversion with duodenal switch (BPD/DS): an observational study. Obes Surg. 2017;27(7):1709–18.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Michel Gagner
    • 1
    • 2
    • 3
    • 4
  1. 1.Herbert Wertheim School of Medicine, FIUMiamiUSA
  2. 2.Hôpital du Sacré CoeurMontrealCanada
  3. 3.Clinique Michel GagnerMontrealCanada
  4. 4.Westmount Square Surgical CenterWestmountCanada

Personalised recommendations