Advertisement

Outcomes of Duodenal Switch and Other Malabsorptive Procedures

  • Peter F. Crookes

The first bariatric operations were entirely malabsorptive and left the stomach untouched. They came to be known as jejunoileal bypass (JIB). In the most popular version of JIB, the jejunum was divided 14 inches beyond the ligament of Treitz and the proximal end anastomosed to the terminal ileum 4 inches from the ileocecal valve (the 14-4 operation). The stimulus to their development was derived from recognition of the short gut syndrome, in which it was clear that patients with massive intestinal resection lost weight despite a high oral intake. The first formal program to follow a series of obese patients after intestinal bypass was developed by a private practice surgeon (J. Howard Payne) and an endocrinologist (Loren DeWind) in Los Angeles, beginning in 1957. Their careful reports identified a number of serious complications that could make their appearance many years after the surgery. These complications included protein- calorie malnutrition and vitamin deficiencies, electrolyte imbalance, renal calculi, and local perianal problems, as a consequence of the extreme malabsorption and the diarrhea it produced. Further, arthropathy and progressive liver failure occurred in a significant percentage of patients, evidently the result of bacterial overgrowth in the lengthy blind loop of intestine (all but 45 cm). Despite the beneficial effects of weight loss and resolution of major comorbidities such as diabetes mellitus, hyperlipidemia, and obstructive sleep apnea, the frequency and potential severity of these problems, often requiring reversal of the bypass, led to the abandonment of intestinal bypass in favor of purely restrictive procedures or a Roux-en-Y reconstruction to a small gastric pouch.

Keywords

Obstructive Sleep Apnea Bariatric Surgery Gastric Bypass Sleeve Gastrectomy Chronic Fatigue Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Selected References

  1. Anthone GJ, Lord RV, DeMeester TR, et al. The duodenal switch operation for the treatment of morbid obesity. Ann Surg 2003;238:618–628PubMedGoogle Scholar
  2. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292(14):1724–1737PubMedCrossRefGoogle Scholar
  3. Cossu ML, Meloni GB, Alagna S, et al. Emergency surgical conditions after biliopancreatic diversion. Obes Surg 2007;17(5):637–641PubMedCrossRefGoogle Scholar
  4. Deveney CW, MacCabee D, Marlink K, et al. Roux-en-Y divided gastric bypass results in the same weight loss as duodenal switch for morbid obesity. Am J Surg 2004;187:655–659PubMedCrossRefGoogle Scholar
  5. Dolan K, Hatzifotis M, Newbury L, et al. A clinical and nutritional comparison of biliopancreatic diversion with and without duodenal switch. Ann Surg 2004;240:51–56PubMedCrossRefGoogle Scholar
  6. Hamoui N, Cantor S, Anthone GJ, et al. Effect of obesity on long term outcome of total knee arthroplasty. Obes Surg 2006;16:35–38PubMedCrossRefGoogle Scholar
  7. Hamoui N, Chock B, Anthone GJ, et al. Revision of the duodenal switch: technique, indications, and outcome. J Am Coll Surg 2007;204(4):603–608PubMedCrossRefGoogle Scholar
  8. Hamoui N, Kim K, Anthone G, et al. The significance of elevated levels of parathyroid hormone in patients with morbid obesity before and after bariatric surgery. Arch Surg 2003;138:891–897PubMedCrossRefGoogle Scholar
  9. Hess DS, Hess DW, Oakley RS. The biliopancreatic diversion with the duodenal switch: results beyond 10 years. Obes Surg 2005;15:408–416PubMedCrossRefGoogle Scholar
  10. Hooper MM, Stellato TA, Hallowell PT, et al. Musculoskeletal findings in obese subjects before and after weight loss following bariatric surgery. Int J Obes (Lond) 2007;31(1):114–1120CrossRefGoogle Scholar
  11. Larrad-Jimenez A, Diaz-Guerra CS, de Cuadros Borrajo P, et al. Short-, mid- and long-term results of Larrad biliopancreatic diversion. Obes Surg 2007;17:202–210PubMedCrossRefGoogle Scholar
  12. Marceau P, Biron S, Bourque RA, et al. Biliopancreatic diversion with a new type of gastrectomy. Obes Surg 1993;3:29–35PubMedCrossRefGoogle Scholar
  13. Marceau P, Hould FS, Simard S, et al. Biliopancreatic diversion with duodenal switch. World J Surg 1998;22:947–954PubMedCrossRefGoogle Scholar
  14. Polizzi A, Schenone M, Sacca SC, et al. Role of impression cytology during hypovitaminosis A. Br J Ophthalmol 1998;82(3):303–305PubMedCrossRefGoogle Scholar
  15. Prachand VN, Davee RT, Alverdy JC. Duodenal switch provides superior weight loss in the super-obese (BMI > or = 50 kg/m2) compared with gastric bypass. Ann Surg 2006;244(4):611–619PubMedGoogle Scholar
  16. Rubino F, Forgione A, Cummings DE, et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg 2006;244(5):741–749PubMedCrossRefGoogle Scholar
  17. Scopinaro N. Biliopancreatic diversion: mechanisms of action and long-term results. Obes Surg 2006;16(6):683–689PubMedCrossRefGoogle Scholar
  18. Scopinaro N, Adami GF, Marinari GM, et al. Biliopancreatic diversion. World J Surg 1998;22(9):936–946PubMedCrossRefGoogle Scholar
  19. Smets KJ, Barlow T, Vanhaesebrouck P. Maternal vitamin A deficiency and neonatal microphthalmia: complications of biliopancreatic diversion? Eur J Pediatr 2006;165(7):502–504PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Peter F. Crookes
    • 1
  1. 1.Associate Professor of Surgery, University of Southern California Department of SurgeryUniversity HospitalLos Angeles

Personalised recommendations