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Laparoscopic Duodenal Switch

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Minimally Invasive Bariatric and Metabolic Surgery

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Abstract

Duodenal switch (DS) consists of a vertical gastrectomy with duodenal preservation (sleeve gastrectomy [SG]), division of the first portion of the duodenum, and reconnection to the distal 250 cm of ileum. The bypassed duodenum, jejunum, and proximal ileum (biliopancreatic limb) are then reconnected to create a Roux-en-Y anatomy with a common channel of 100 cm and an alimentary channel of 150 cm.

DS can be performed safely as a single-step procedure in the hands of experienced surgeons. However, the staged approach (SG followed by DS) presents several advantages: the opportunity to detect patients who might achieve good results with SG alone, the selection of patients for the second step who are compliant, simplification of the surgical technique, and a reduction of postoperative morbidity.

The DS is mainly used in super-obese patients (BMI >50 kg/m2) as it results in an excess weight loss (EWL) between 66 and 76 % in the long term, which is far better than what is reported for other bariatric procedures such as gastric banding (AGB) or gastric bypass (RYGB).

DS has a marked effect on obesity-related metabolic comorbidities, specifically type 2 diabetes mellitus (T2DM): the reported rates of resolution vary between 86 and 100 %. Concordantly, hypertension shows marked improvement (54–95 % resolution rate), as well as dyslipidemia (72–100 % remission rate) and obstructive sleep apnea (90–100 % resolution rate).

The reasons why such an effective procedure is the least performed worldwide are multiple. As first, its technical complexity plays a major role: it is time consuming and requires a skilled surgeon, especially using laparoscopy. Furthermore, DS is associated with an increased operative mortality and an increased risk of metabolic complications (protein energy malnutrition and other nutrient deficiencies) compared with the other bariatric procedures. Finally, DS carries the risk of two specific complications that are sometimes life threatening: the protein deficiency syndrome and the intestinal bacterial overgrowth syndrome.

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Authors and Affiliations

  1. Service de Chirurgie Digestive et ttransplantation hépatique – Hôpital Archet 2, Centre Hospitalo-Universitaire Université de Nice Sophia Antipolis, 151 route ST Antoine de Ginestière, Nice, 06202, France

    Antonio Iannelli & Francesco Martini

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  1. Antonio Iannelli
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  2. Francesco Martini
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Correspondence to Antonio Iannelli .

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Editors and Affiliations

  1. General and Emergency Surgery, Bariatric Surgery, Careggi University Hospital, Florence, Italy

    Marcello Lucchese

  2. Department of Surgery, Medical School, University of Genoa, Genoa, Italy

    Nicola Scopinaro

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Iannelli, A., Martini, F. (2015). Laparoscopic Duodenal Switch. In: Lucchese, M., Scopinaro, N. (eds) Minimally Invasive Bariatric and Metabolic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-15356-8_21

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  • DOI: https://doi.org/10.1007/978-3-319-15356-8_21

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