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Laparoscopic Reversal of the Biliopancreatic Diversion with Duodenal Switch: a Step by Step Video Case

Abstract

Background

Despite the success of the Biliopancreatic Diversion with Duodenal Switch procedure (BPD-DS) in weight loss and comorbidities resolution, reversal of BPD-DS is necessary in 0.2–0.6% of BPD-DS cases for vitamin, protein, and other micronutrient deficiencies. Different techniques are available to reverse the malabsorptive component of the BPD-DS.

Methods

A retrospective chart review for a 37-year-old female patient who presented with lower leg edema and signs of malnutrition 5 years after a BPD/DS. The patient was not compliant with the required daily vitamin and protein intake. Thus, after extensive discussion with the patient, a decision was made to reverse the malabsorptive component of the BPD-DS.

Results

A laparoscopic reversal of the malabsorptive component of the BPD-DS was concluded by transecting the roux limb distally at the ileo-ileal anastomosis and reconnecting it to the proximal jejunum thus substantially lengthening the common channel for absorption. At 6 months follow-up, the patient normalized her vitamin deficiency and had a normal level of serum protein. Her weight, BMI, EWL%, and TBWL% were 72 kg, 27.5 kg/m2, 90%, and 45%, respectively.

Conclusions

Proper nutrition and vitamin supplementation is essential to avoid nutritional complications. Different techniques are available to reverse the malabsorptive component of the BPD-DS. However, no standard approach is adopted by the surgical community. We demonstrate our preferred technique in reversing the malabsorptive component of the BPD-DS.

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Acknowledgements

We sincerely thank Farah Khalifeh, M.S.c. for reviewing this paper.

Author information

Correspondence to Hamzeh M. Halawani.

Ethics declarations

Ethical Approval

This study has been approved by the institutional research ethics committee and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Halawani, H.M., Antanavicius, G. Laparoscopic Reversal of the Biliopancreatic Diversion with Duodenal Switch: a Step by Step Video Case. OBES SURG 27, 3327–3329 (2017) doi:10.1007/s11695-017-2945-6

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Keywords

  • Biliopancreatic diversion
  • Duodenal switch
  • Reversal
  • Reoperation
  • Malnutrition
  • Bariatric