A switch to the Duodenal Switch
DOI:
https://doi.org/10.19230/jonnpr.3116Keywords:
Morbid obesity, Duodenal Switch, Bariatric surgery, Sleeve-Forming Gastrectomy, Biliary pancreatic diversion, Weight lossAbstract
Background. Duodenal Switch (DS) is a procedure that combines a Sleeve-Forming Gastrectomy (SFG) plus a biliopancreatic diversion (BPD) for the treatment of morbid obesity (MO) with a higher weight loss and resolution of comorbidities.
Objectives. Report our experience with 950 consecutive DS operations performed from 1994 to 2016. Setting. Mix of teaching and private institution in a county hospital of Spain.
Methods. We report an observational, retrospective and longitudinal study of 950 consecutive morbidly obese patients treated by DS surgery.
Results. We performed 518 open and 432 laparoscopic DS. Operative mortality was 0.84% (1.38% in DS and 0.38% in LDS), 4.84% had leaks, two had hepatic failures (0.2%) and malnutrition was present in 3.1%. At 5 years, the percentage of BMI lost was 80%, and percentage of expected BMI loss was more than 100%.
Conclusions. DS is the most aggressive bariatric surgery (BS) technique, but with the best long-term weight loss. We describe operative complications and long-term follow-up guidelines.
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References
Scopinaro N, Gianetta E, Civalleri D, et al: Biliopancreatic bypass for obesity: I. An experimental study in dogs. Br J Surg 1979; 66:613-7
Scopinaro N, Gianetta E, Civalleri D et al: Two years of clinical experience with biliopancreatic bypass for obesity. Am J Clin Nutr 1980; 33:506-14
Hess DS, Hess DW: Biliopancreatic Diversion with a Duodenal Switch. Obes Surg 1998; 8:267-282
Hess D: Limb Measurements in Duodenal Switch. Obes Surg 2003; 13:966
Lagacé M, Marceau P, Marceau S. et al.: Biliopancreatic Diversion with a New Type of Gastrectomy: Some Previous Conclusions Revisited. Obes Surg 1995; 5:411-418
Marceau P, Hould FS, Simard S. et al: Biliopancreatic Diversion with Duodenal Switch. World J. Surg. 1998; 22:947–954.
Hess DS, Hess DW, Oakley RS: The Biliopancreatic Diversion with the Duodenal Switch: Results beyond 10 Years. Obes Surg 2005; 15:408-416
Baltasar A, Bou R, Bengochea M.: Hybrid bariatric Surgery: Duodenal Switch and biliopancreatic diversion. Video-Revista de Cirugía. VCR 1996; 12:16-41. www.youtube.com/watch?v=3mNnZte3W_I&feature=youtu.be
Baltasar M, Bou R, Cipagauta LA y col.: Hybrid Bariatric Surgery: Bilio-pancreatic Diversion and Duodenal Switch - Preliminary Experience. Obes Surg 1995; 5:419-423.
Baltasar A, del Río J, Bengochea M, y col.: Cirugía híbrida bariátrica: Cruce duodenal en la derivación bilio- pancreática. Cir. Esp. 1996; 59:483-486.
Baltasar A, del Río J, Escrivá C et al. Preliminary results of the duodenal switch. Obes Surg 1998; 7:500-4.
Baltasar A., Bou R, Miró J, Pérez N: Cruce duodenal por laparoscopia en el tratamiento de la obesidad mórbida: técnica y estudio preliminar. Cir Esp. 2001; 70:102-104.
Baltasar A, Bou R, Bengochea M y col.: Duodenal switch: an effective therapy for morbid obesity-intermediate results. Obes Surg 2001; 11:54-8.
Baltasar A, Bou R, Bengochea M.: Open Duodenal Switch. Video. BMI-2011, 1.5.4 (356-359). www.youtube.com/watch?v=h0nTzeUDI5o
Baltasar A.: Hand-sewn Laparoscopic duodenal Switch. Surg Obes Relat Dis 2007; 3:94-6
Anthone G, Lord R, DeMeester T, et al: The Duodenal Switch Operation for the Treatment of Morbid Obesity. Ann Surg. 2003; 238(4): 618–628.
Almogy G, Crookes P, Anthone G. Longitudinal Gastrectomy as a Treatment for the High-Risk Super-Obese Patient. Obes Surg 2004; 14, 492-497
Rabkin RA.: Concept. The duodenal switch as an increasing and highly effective operation for morbid obesity. Obes Surg 2004; 14: 861-865.
Ren CJ, Patterson E, Gagner M. Early results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients. Obes Surg 2000; 10:514-523.
Baltasar A, Bou R, Miró J. et al.: Avances en técnica quirúrgica. Cruce duodenal por laparoscopia en el tratamiento de la obesidad mórbida: técnica y estudio preliminar. Cir. Esp. 2001; 70:102-104. www.youtube.com/watch?v=GSfzgYYxZJ8.
Weiner RA; Blanco-Engert R.; Weiner S et al.: Laparoscopic biliopancreatic diversion with duodenal switch: Three different duodeno-ileal anastomotic techniques and initial experience. Obes Surg 2004; 14:334-340
Paiva D, Bernardes L, Suretti L.: Laparoscopic Biliopancreatic Diversion for the Treatment of Morbid Obesity: Initial Experience. Obes Surg 2001; 11:619-622
Scopinaro N; Marinari G, Camerini G.: Laparoscopic Standard Biliopancreatic Diversion: Technique and Preliminary Results. Obes Surg 2002; 12:241-244
Baltasar A, Perez N, Serra C, Marceau P et al.: Weight Loss Reporting: Predicted BMI after Bariatric Surgery. Obes Surg 2011; 21:367–372. DOI 10.1007/s11695-010-0243-7
Molina A, Fàtima F, Vives M, et al. Usefulness of Baltasar’s expected body mass index as an indicator of bariatric weight loss surgery. Obes Surg 2016. DOI 10.1007/s11695-016-2163-7
Serra C, Pérez N, Bou R, Baltasar A.: Sliding Self-Locking First Stitch and Aberdeen Knots in Suture Reinforcement with Omentoplasty of the Laparoscopic Gastric Sleeve Staple line. Obes Surg 2014; 24:1739–1740. DOI 10.1007/s11695-014-1352-5 https://www.youtube.com/watch?v=i4kNc8PJcEk
Baltasar A, Bou R, Serra R, Bengochea M and Pérez N: Use of self-locking knots in running intestinal bariatric sutures. Glob Surg, 2015; 2:100-101. doi:10.15761/GOS.1000132
Cuschieri A. Szabo Z, West D.: Tissue Approximation in Endoscopic Surgery: Suturing & Knotting. Informa Healthcare 1995 November. ISBN-13: 9781899066032
Baltasar, R. Bou, J. Miró, M. Bengochea, N. Pérez. Hand-sutured laparoscopic duodenal switch. Technical aspects. V13. Obes Surg. 2012; 12: 402
Baltasar A, Bou R, Bengochea M et al.: Emergency Tracheotomy in Morbid Obesity. Sci Forschen. Obes Open Access 3(2): doi http://dx.doi.org/10.16966/2380-5528.132
Baltasar A, Bou R, Bengochea M, Serra C, Pérez N.: Difficult intubation and emergency tracheotomy in morbid obesity. BMI-Latina 2013; 3:4-7
Baltasar A. Wall-stent prosthesis for severe leak and obstruction of the duodenal switch. Obes Surg 2000; 10: 2:29
Serra C, Baltasar A, Andreo L. et al: Treatment of Gastric Leaks with Coated Selfexpanding Stents after Sleeve Gastrectomy. Obes Surg 2007; 17:866-872
Serra C, Baltasar A, Pérez N. et al: Total Gastrectomy for Complications of the Duodenal Switch, with Reversal. Obes. Surg 2006; 16:1082-1086
Baltasar A, Bou R, Bengochea M, et al. Use of a Roux limb to correct esophago-gastric junction fistulas after sleeve gastrectomy. Obes Surg 2007; 17:1409–10
Baltasar A, Serra C, Bengochea M et al: Use of Roux limb as remedial surgery for sleeve gastrectomy fistulas. Surg Obes Relat Dis 2008; 4:759–763
Mcheimeche H, Dbouk S, Saheli R et al. Double Baltazar Procedure for Repair of Gastric Leakage Post-Sleeve Gastrectomy from Two Sites: Case Report of New Surgical Technique. Obes Surg 2018; 28:2092–2095.
Baltasar A, Serra C, Pérez N, et al. Clinical Hepatic Impairment after the Duodenal Switch. Obes Surg 2014; 14:77–8.
Baltasar A.: Liver failure and transplantation after duodenal switch. Surg Obes Relat Dis 2014; 10: c93-c96.
Baltasar A, Bou R, Bengochea M, Serra C.: Malnutrición calórico-proteica. Tres tipos de alargamiento de asa común. BMI-Latina 2011; 5:96-97.
Baltasar A, Bou R, Bengochea M: Fatal perforations in laparoscopic bowel lengthening operations for malnutrition. Surg Obes Relat Dis 2010; 6:572–574 www.youtube.com/watch?v=Hw_aPYLjGXI
Bueno J, Pérez N, Serra C et al. Fistula pancreato-cutánea secundaria a pancreatitis postoperatoria tras cruce duodenal laparoscópico. Cir. Esp 2004; 76:184–6.
Buchwald H.: 2004 ASBS. Consensus Conference Statement Bariatric surgery for morbid obesity: Health implications for patients, health professionals, and third-party payers. Surg Obes Relat Dis 2005; 1:371–381
Deitel M, Gagner M, Erickson AL, et al. Third International Summit. Current Status of sleeve gastrectomy. Surg Obes Relat Dis 2011; 7: 749–59.
Mason R. Diagnosis and treatment of rapid pulse. Obes Surg 1995; 3:341
Duncan T, Tuggle K, Larry Hobson L et al. PL-107. Feasibility of laparoscopic gastric bypass performed on an outpatient basis. SOARD 2011; 7: 339–354
Baltasar A.: Simple bariatric tele-medicine. BMI-Latina 2015; 5:901-902
Baltasar A. WhatsApp© Assistance in Bariatric Surgery Journal of Obesity & Eating Disorders ISSN 2471-8203. 2017. 3;1:28. DOI: 10.21767/2471-8513.100017
DeMaria E, Pate V, Warthen M. et al: Original article Baseline data from American Society for Metabolic and Bariatric Surgery-designated Bariatric Surgery Centers of Excellence using the Bariatric Outcomes Longitudinal Database. SOARD 2010; 6:347–355
Nelson D, Blair KS, MD; Martin M.: Analysis of Obesity-Related Outcomes and Bariatric Failure Rates with the Duodenal Switch vs Gastric Bypass for Morbid Obesity. Arch Surg 2012; 147:847-854
English W, DeMaria M, Brethauer SA et al.: American Society for Metabolic and Bariatric Surgery estimation of metabolic and bariatric procedures performed in the United States in 2016. SOARD 2018; 14:259–263
Iannelli A, Schneck AS, Topart P. et al.: Laparoscopic sleeve gastrectomy followed by duodenal switch, in selected patients versus single-stage duodenal switch for superobesity: case– control study. SOARD 2013; 9: 531– 538
Biertho L, Lebel S, Marceau S et al.: Perioperative complications in a consecutive series of 1000 duodenal switches. SOARD 2013. 9:63–68
Biertho L, Simon-Hould F, Marceau S, et al. Current Outcomes of Laparoscopic Duodenal Switch. Ann Surg Innov. Res 2016; 10:1. DOI 10.1186/s13022-016-0024-7
Biron S, Biertho L, Marceau S. Long-term follow-up of disease-specific quality of life after bariatric surgery. Surg Obes Relat Dis 2018 Accepted SOARD 3291
Prachand V, DaVee R, Alberdy JA.: Duodenal switch provides superior weight loss in the super-obese (BMI>50) compared with gastric bypass. Annals of Surg 2006; 244:611-619.
Strain CW, Gagner M, Inabnet WB 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; 3:31-36
Topart P, Becouarn G, Salle A. Five-year follow-up after biliopancreatic diversion with duodenal Switch. Surg Obes Relat Dis 2011; 7:199–205
Våge V, Gåsdal R, Lakeland C et al. The Biliopancreatic Diversion with a Duodenal Switch (BPDDS): How Is It Optimally Performed? Obes Surg 2011; 21:1864–1869.
Angrisani L, Santonicola A, Iovino P et al. IFSO Worldwide Survey 2016: Primary, Endoluminal, and Revisional Procedures. Obes Surg 2018; 28:3783–3794 https://doi.org/10.1007/s11695-018-3450-2
Rabkin R, Rabkin JM, Metcalf B. et al.: Nutritional Markers following Duodenal Switch for Morbid Obesity. Obes Surg 2004; 14:84-90.
Keshishian A, Zahriya K, Willes EB.: Duodenal Switch Has No Detrimental Effects on hepatic Function and Improves Hepatic Steatohepatitis after 6 Months. Obes Surg 2005; 15: 1418-1423
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. e5.
Tsoli M, Chronaiou A, Kehagias I.: Hormone changes and diabetes resolution after biliopancreatic diversion and laparoscopic sleeve gastrectomy: a comparative prospective study. Surg Obes Relat Dis 2013; 9:667–678.
Baltasar A. Primera operación metabólica de diabetes en España. BMI-Latina 2016; 6:996-9
Våge V, Roy M., Nilsen M, Berstad M. Predictors for Remission of Major Components of the Metabolic Syndrome after Biliopancreatic Diversion with Duodenal Switch. Obes Surg 2013; 23:80–86 DOI 10.1007/s11695- 012-0775-0
Marceau P, Biron S, Marceau S et al K.: Biliopancreatic Diversion-Duodenal Switch: Independent Contributions of Sleeve Resection and Duodenal Exclusion. Obes Surg 2014; 24:1843–1849.DOI 10.1007/s11695- 014-1284-0
Moustarah F, Marceau S, and Lebel S, et al.: Weight Loss after Duodenal Switch without Gastrectomy for the treatment of Severe Obesity: Review of a single institution Case Series of Duodeno-Ileal Intestinal Bypass. Can J Surg. 2010; 53(4): S51.
Larrad A, Moreno B, Camacho A. Resultados a los dos años de la técnica de Scopinaro en el tratamiento de la obesidad mórbida. Cir. Esp. 1995; 58: 23. 22.
Larrad A; Sánchez-Cabezudo C; Borrajo et al. Short-, Mid- and Long-Term Results of Larrad Biliopancreatic Diversion. Obes Surg,2007; 17, 202-210
Solano J, Resa JJ, J A Fatas et al.: Derivación bilio-pancreática laparoscópica para el tratamiento de la obesidad mórbida. Aspectos técnicos y análisis de los resultados preliminares
Ballesteros M, González T, Urioste A.: Biliopancreatic Diversion for Severe Obesity: Long-Term Effectiveness and Nutritional Complications. Obes Surg 2016; 26:38–44 DOI 10.1007/s11695-015-1719-2
Hoyuela C, Veloso E, Marco C. Derivación bilio-pancreática con cruce duodenal y su impacto en las complicaciones posoperatorias. Cir. Esp. 2006;80 Supl 1:1-250 175
Sánchez-Pernaute A, Rubio M, Torres A et al. Proximal Duodenal–Ileal End-to-Side Bypass with Sleeve Gastrectomy: Proposed Technique. Modern surgery: Technical innovation Obes Surg (2007) 17:1614–1618 DOI 10.1007/s11695-007-9287-8
Halawani HM, Antanavicius G, Bonanni F.: How to Switch to the Switch: Implementation of Biliopancreatic Diversion with Duodenal Switch into Practice. Obes. Surg. 2017; 27 (9): 2506-2509. doi: 10.1007 / s11695-017- 2801-8.
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