Biliopancreatic Diversion With Duodenal Switch

Book
In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.
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Excerpt

Surgical management for the treatment of obesity was an idea that arose from clinical observations of weight loss seen in patients after undergoing resections of either their stomach or small bowel. One of the initial weight loss procedures developed in 1954 was called the jejunoileal bypass. This procedure was abandoned due to its terrible side effect profile. These negative side effects resulted in conveyed weight loss procedures in an unpopular light.

A few pivotal changes in the public's perception of bariatric surgery have included:

  1. The National Institutes of Health consensus conference in 1992 endorsing vertical gastric banding as a safe and effective means for weight loss surgery

  2. A paper published in 1995 showing the positive long-term effects of bariatric surgery on the management of diabetes mellitus

  3. Improved bariatric equipment, which decreased postoperative complications.

In 1994, the first laparoscopic gastric bypass surgery was performed. As the learning curve leveled for laparoscopy, laparoscopic procedures surpassed open surgery in positive measurable outcomes; decreased wound complications, incisional hernias rates, length of stay, and decreased overall mortality.

Bariatric surgery is an effective modality that can maintain weight loss and decrease obesity-associated comorbid conditions. Obesity is related to the development of comorbidities such as type 2 diabetes, heart disease, hypertension, sleep apnea, and different orthopedic disabilities. Common bariatric surgical procedures that are completed today are the sleeve gastrectomy, Roux en-Y gastric bypass, and the biliopancreatic diversion with duodenal switch. The Biliopancreatic diversion was first described by Scorpinaro in 1979. This procedure combined a horizontal gastric resection with the closure of a duodenal stump, gastroileal anastomosis, and an ileoileal anastomosis, to create a 50-cm common channel and a 250-cm alimentary channel.

Patients who underwent this procedure suffered from bile gastritis, so it was modified to the duodenal switch procedure by DeMeester in 1987. The duodenal switch evolved into the modern-day biliopancreatic diversion with the duodenal switch procedure, which includes a sleeve gastrectomy, the transection of the duodenum distal to the pylorus, and the creation of an alimentary limb 200- to 250-cm long.

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  • Study Guide