Second-Stage Robot-Assisted Biliopancreatic Diversion with Duodenal Switch After Sleeve Gastrectomy


Biliopancreatic diversion (BPD) was initially described in 1979 and consisted of a distal gastrectomy with a 250-mL stomach pouch and a distal intestinal bypass with a 50 to 100-cm common channel resulting in malabsorption of dietary fat (Scopinaro et al. Br J Surg. 66(9):618–20, 1979). Later, several modifications (sleeve gastrectomy, pylorus preservation, and duodenal switch) were proposed to improve incidence of postoperative dumping syndrome, diarrhea, and anastomotic ulcerations (Lagacé et al. Obes Surg. 5(4):411–8, 1995). Gagner et al. developed a simplified and reproducible approach for laparoscopic BPD with duodenal switch (BPD-DS) after sleeve gastrectomy (Ren et al. Obes Surg. 10(6): 514–23, 2000). BPD-DS has been considered as one of the most difficult bariatric procedures for its surgical complexity and postoperative metabolic complications management. In this regard, the number of BPD-DS has remained extremely low (<4 %). We hypothesize that robotic approach could facilitate the feasibility of BPD-DS procedure. In this multimedia video (8 min), we present a step-by-step robotic BPD-DS.

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Conflict of interest

The authors declare that they have no conflicts of interest concerning this article.

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Correspondence to G. Fantola.

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(MOV 229389 kb)

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent was obtained from all individual participants included in the study.

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Fantola, G., Reibel, N., Germain, A. et al. Second-Stage Robot-Assisted Biliopancreatic Diversion with Duodenal Switch After Sleeve Gastrectomy. OBES SURG 25, 197–198 (2015) doi:10.1007/s11695-014-1494-5

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  • Duodenal switch
  • Biliopancreatic diversion
  • Robotic surgery
  • Obesity surgery
  • New technologies