Laparoscopic Duodenal Switch

Laparoscopic biliopancreatic diversion with duodenal switch (BPD-DS) is one of the most effective weight loss procedures currently available. Both short- and long-term weight loss exceed that of any other bariatric operation. BPD-DS involves a 150- to 200-cc sleeve or vertical gastrectomy, a duodenoileal anastomosis, and a long Roux-en-Y with a 150-cm alimentary limb and a 100-cm common channel (Fig. 14.1). The key features of this operation are that the lesser curvature, antrum, pylorus, first portion of the duodenum, and vagal innervation are all spared, while parietal cell mass is reduced, thus allowing a better digestive behavior while decreasing the likelihood of the dumping syndrome and marginal ulceration. Furthermore, by placing the ileoileal anastomosis 100 cm proximal to the ileocecal junction (instead of 50 cm, as in the classic Scopinaro BPD), metabolic disturbances and the number of surgical revisions for malnutrition or diarrhea are considerably less.