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A Brief History of the Duodenal Switch

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Duodenal Switch and Its Derivatives in Bariatric and Metabolic Surgery

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Abstract

The duodenal switch procedure, more correctly named the biliopancreatic diversion with duodenal switch (BPD-DS) is a bariatric-metabolic procedure. Based on the classic biliopancreatic diversion designed by Nicola Scopinaro, it was specifically designed to address some long-term issues that had arisen after this latter operation, such as anastomotic ulcerations and malnutrition. Based on the work of Tom DeMeester, who aimed at reducing duodenogastric reflux, some essential adaptations were implemented by Hess (USA) and Marceau (Canada) to benefit the patient suffering from obesity. Importantly, the procedure was translated to a laparoscopic operation in humans by Michel Gagner in 1999.

Historically, there are three essential components to the BPD-DS: the sleeve gastrectomy, the transection of the duodenum some 3 cm distal to the pylorus, and the restoration of intestinal continuity following the Roux technique, usually with a Roux limb of some 250 cm that is anastomosed to the proximal end of the duodenum and an entero-enterostomy performed at some 100 cm from the ileocecal valve (Marceau technique). As in all Roux constructions, the mesenteric defects (Petersen’s and at the jejunoileal anastomosis) must be closed to avoid internal hernias. In several long-term observational studies, the results of the BPD-DS appear to be good to excellent, but often at the cost of some significant undesired side effects and surgical complications. In order to limit complications, a staged strategy was designed that consisted of a sleeve gastrectomy performed as step one, followed if needed by the duodenal switch part at a later stage. In an effort to further simplify the technique, in recent years the Roux construction was replaced by a single duodeno-ileal loop anastomosis (SADI-S), whereas the sleeve gastrectomy was maintained.

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References

  1. DeMeester T, Fuchs K, Ball C, Albertucci M, Smyrk T, Marcus J. Experimental and clinical results with proximal end to end duodenojejunostomy for pathologic duodenogastric reflux. Ann Surg. 1987;206:414–26.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Hinder RA. Duodenal switch: a new form of pancreaticobiliary diversion. Surg Clin North Am. 1992;72(2):487–99.

    Article  CAS  PubMed  Google Scholar 

  3. Perniceni T, Gayet B, Fekete F. Total duodenal diversion in the treatment of complicated peptic oesophagitis. Br J Surg. 1988;15:1108–11.

    Google Scholar 

  4. Buchwald A. Metabolic surgery: a brief history and perspective. Surg Obes Relat Dis. 2010;6(2):221–2.

    Article  PubMed  Google Scholar 

  5. Mason E, Ito C. Gastric bypass. Ann Surg. 1969;170(3):329–39.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Griffen W Jr. Gastric Bypass. Am Surg. 1984;50(9):496–501.

    PubMed  Google Scholar 

  7. Roux C. De La Gastro-Entérostomie Revue de Gynecologie et de Chirurgie Abdominale, vol. 1. 1897. p. 67–122.

    Google Scholar 

  8. Scopinaro N, Marinari GM, Camerini G. Laparoscopic standard biliopancreatic diversion: technique and preliminary results. Obes Surg. 2002;12(2):241–4.

    Article  PubMed  Google Scholar 

  9. Gagner M. For whom the bell tolls? It is time to retire the classic BPD (bilio-pancreatic diversion) operation. Surg Obes Relat Dis. 2019;15(6):1029–31.

    Article  PubMed  Google Scholar 

  10. Hess DS, Hess DW. Biliopancreatic diversion with a duodenal switch. Obes Surg. 1998;8(3):267–82.

    Article  CAS  PubMed  Google Scholar 

  11. Marceau P, Hould F, Simard S, Lebel S, Bourque R, Potvin M, Biron S. Biliopancreatic diversion with duodenal switch. World J Surg. 1998;22(9):947–54.

    Article  CAS  PubMed  Google Scholar 

  12. Marceau P, Hould FS, Lebel S, Marceau S, Biron S. Malabsorptive obesity surgery. Surg Clin North Am. 2001;81(5):1113–27.

    Article  CAS  PubMed  Google Scholar 

  13. Hess D. Limb measurements in duodenal switch. Obes Surg. 2003;13(6):966.

    Article  PubMed  Google Scholar 

  14. Feng J, Gagner M. Laparoscopic biliopancreatic diversion with duodenal witch. Semin Laparosc Surg. 2002;9(2):125–9.

    Article  PubMed  Google Scholar 

  15. Regan JP, Inabnet WB, Gagner M, Pomp A. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg. 2003;13(6):861–4.

    Article  CAS  PubMed  Google Scholar 

  16. Hamoui N, Anthone GJ, Kaufman HS, Crookes P. Sleeve gastrectomy in the high-risk patient. Obes Surg. 2006;16(11):1445–9.

    Article  PubMed  Google Scholar 

  17. Carmichael A, Johnston D, Barker M, Bury R, Boyer J, Sue-Ling H. Gastric emptying after a new, more physiological anti-obesity operation: the Magenstrasse and Mill procedure. Eur J Nucl Med. 2001;28(9):1379–83.

    Article  CAS  PubMed  Google Scholar 

  18. Sarela AI, Dexter SP, O’Kane M, Menon A, McMahon MJ. Long-term follow-up after laparoscopic sleeve gastrectomy: 8-9-year results. Surg Obes Relat Dis. 2012;8(6):679–84.

    Article  PubMed  Google Scholar 

  19. Scopinaro N, Adami GF, Marinari GM, Gianetta E, Traverso E, Friedman D, Camerini G, Baschieri G, Simonelli A. Biliopancreatic diversion. World J Surg. 1998;22(9):936–46.

    Article  CAS  PubMed  Google Scholar 

  20. Ferrer-Marquez M, Garcia-Diaz J, Moreno-Serrano A, Garcia-Diaz JM, Ferrer-Ayza M, Alarcon-Rodriguez L, Artero E, Soriano-Maldonado A. Changes in gastric volume and their implications for weight loss after laparoscopic sleeve gastrectomy. Obes Surg. 2017;27(2):303–9.

    Article  PubMed  Google Scholar 

  21. Parmar CD, Mahawar KK, Boyle M, Schroeder N, Balupuri S, Small PK. Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass is effective for gastro-oesophageal reflux disease but not for further weight loss. Obes Surg. 2017;27(7):1651–8.

    Article  PubMed  Google Scholar 

  22. Biertho L, Thériault C, Bouvet L, Marceau S, Hould FS, Lebel S, Julien F, Tchernof A. Second-stage duodenal switch for sleeve gastrectomy failure: a matched controlled trial. Surg Obes Relat Dis. 2018;14(10):1570–9.

    Article  PubMed  Google Scholar 

  23. Iannelli A, Schneck AS, Topart P, Carles M, Hébuterne X, Gugenheim J. Laparoscopic sleeve gastrectomy followed by duodenal switch in selected patients versus single-stage duodenal switch for superobesity: case-control study. Surg Obes Relat Dis. 2013;9(4):531–8.

    Article  PubMed  Google Scholar 

  24. Biertho L, Lebel S, Marceau S, Hould FS, Julien F, Biron S. Biliopncreatic diversion with duodenal switch: surgical technique and perioperative care. Surg Clin North Am. 2016;96(4):815–26.

    Article  PubMed  Google Scholar 

  25. Bolckmans R, Himpens J. Long-term (>10 yrs) outcome of the laparoscopic biliopancreatic diversion with duodenal switch. Ann Surg. 2016;264(6):1029–37.

    Article  PubMed  Google Scholar 

  26. Biron S, Biertho L, Marceau S, Lacasse Y. Long-term follow-up of disease-specific quality of life after bariatric surgery. Surg Obes Relat Dis. 2018;14(5):658–64.

    Article  PubMed  Google Scholar 

  27. Scopinaro N, Gianetta E, Adami G, Friedman D, Traverso E, Marinari G, Cuneo S, Vitale B, Ballari F, Colombini M, Baschieri G, Bachi V. Biliopancreatic diversion for obesity at eighteen years. Surgery. 1996;119(3):261–8.

    Article  CAS  PubMed  Google Scholar 

  28. Angrisani L, Santanicola A, Iovino P, Vitiello A, Higa K, Himpens J, Buchwald H, Scopinaro N. IFSO worldwide survey 2016: primary, endoluminal and revisional proceduires. Obes Surg. 2018;28(12):3783–94.

    Article  PubMed  Google Scholar 

  29. Merz A, Blackstone R, Gagner M, Torres A, Himpens J, Higa K, Rosenthal R, Lloyd A, DeMaria E. Duodenal switch in revisional bariatric surgery: conclusions from an expert consensus panel. Surg Obes Relat Dis. 2019;15(6):894–9.

    Article  PubMed  Google Scholar 

  30. Sanchez-Pernaute A, Herrera M, Perez-Aguirre A, Garcia Perez J, Cabrerizo L, Diez Valladares L, Fernandez C, Talavera P, Torres A. Proximal duodenal-ileal end-to-side bypass with sleeve gastrectomy: proposed technique. Obes Surg. 2007;17(12):1614–8.

    Article  PubMed  Google Scholar 

  31. Surve A, Zaveri H, Cottam D, Belnap LG, Cottam A, Cottam S. A retrospective comparison of biliopancreatic diversion with duodenal switch with single anastomosis duodenal switch (SIPS-stomach intestinal pylorus sparing surgery) at a single institution with two year follow-up. Surg Obes Relat Dis. 2017;13(3):415–22.

    Article  PubMed  Google Scholar 

  32. Csendes A, Orellana O, Martinez G, Burgos AM, Figueroa M, Lanzarini E. Clinical, endoscopic and histologic findings at the distal esophagus and stomach before and late (10.5 years) after laparoscopic sleeve gastrectomy: results of a prospective study with 93% follow-up. Obes Surg. 2019;29(12):3809–17.

    Article  PubMed  Google Scholar 

  33. Yashkov Y, Bordan N, Torres A, Malykhina A, Bekuzarov D. SADI-S 250 vs Roux-en-Y duodenal switch (RY-DS): results of a 5-year observational study. Obes Surg. 2021;31(2):570–9.

    Article  PubMed  Google Scholar 

  34. Topart P, Becouarn G. The single anastomosis duodenal switch modifications: a review of the current literature on outcomes. Surg Obes Relat Dis. 2017;13(8):1306–12.

    Article  PubMed  Google Scholar 

  35. Roslin M. Comment on: single and dual anastomosis duodenal switch for obesity treatment: a single center experience. Surg Obes Relat Dis. 2021;17(1):19–21.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. CHIREC Delta Hospital, Brussels, Belgium

    Jacques M. Himpens

Authors
  1. Jacques M. Himpens
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Editor information

Editors and Affiliations

  1. Bariatric Surgery Department, Orlando Health, Orlando, FL, USA

    Andre Teixeira

  2. Bariatric Surgery Department, Orlando Health, Orlando, FL, USA

    Muhammad A. Jawad

  3. Bariatric Endoscopy, Mohak Bariatric and Robotic Center at Sri Aurobindo Medical College, Indore, Madhya Pradesh, India

    Manoel dos Passos Galvão Neto

  4. Medical School, Universidad Complutense de Madrid (UCM); IdISSC, Hospital Clínico San Carlos; Complutense University, Madrid, Madrid, Spain

    Antonio Torres

  5. Bariatric and general surgery, Quebec Heart and Lung Institute, Laval University, Quebec, QC, Canada

    Laurent Biertho

  6. Bariatric Surgery, Clínica Caetano Marchesini, Curitiba, Paraná, Brazil

    João Caetano Marchesini

  7. Div of Surgery, Minimally Invasive, The University of Texas Health Science C, Bellaire, TX, USA

    Erik Wilson

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2. The artist work is original.

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Himpens, J.M. (2023). A Brief History of the Duodenal Switch. In: Teixeira, A., et al. Duodenal Switch and Its Derivatives in Bariatric and Metabolic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-25828-2_1

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  • DOI: https://doi.org/10.1007/978-3-031-25828-2_1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-25827-5

  • Online ISBN: 978-3-031-25828-2

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