Biliopancreatic Diversion with Duodenal Switch

Abstract

In 1990 Scopinaro's technique of biliopancreatic diversion with distal gastrectomy (DG) and gastroileostomy was modified. A sleeve gastrectomy with duodenal switch (DS) was used instead of the distal gastrectomy; and the length of the common channel was made 100 cm instead of 50 cm. A questionnaire and a prescription for blood work were sent to 252 patients who underwent DG a mean 8.3 years ago (range 6-13 years) and 465 patients who underwent DS 4.1 years ago (range 1.7-6.0 years). The questionnaire response rate was 93%, and laboratory work was completed for 65% of both groups. The mean weight loss after DG was 37 +/- 21 kg and after DS 46 +/- 20 kg. There were fewer side effects after DS: The number of daily stools was lower (p < 0.0002), as was the prevalence of diarrhea (p < 0.01), vomiting (p < 0.001), and bone pain (p < 0.001). Greater benefits related to several aspects of life were reported after DS than DG (p < 0.0001). The mean serum levels of ferritin, calcium, and vitamin A were higher (p < 0.001), and parathyroid hormone was lower. The yearly revision rate for excessive malabsorption was 1.7% per year after DG and 0.1% per year after DS. The two procedures were equally efficient for treating co-morbid conditions such as diabetes, hypertension, and hypercholesterolemia. Biliopancreatic diversion with sleeve gastrectomy/duodenal switch and a 100-cm common limb was shown to produce greater weight loss with fewer side effects.

Evidence-based medicine reports on obesity surgery: a critique

“…Furthermore, it did not review the data in the large series of these two procedures by Scopinaro et al 101 or Marceau and colleagues. 103 It also made conflicting statements about the three different variants of gastric bypass studied by Brolin et al 104,105 Their representation that the 'long-limb' gastric bypass is associated with excessive nutritional and vitamin deficiencies from malabsorption is incorrect, as it refers to the more malabsorptive 'distal' gastric bypass operation 104 Owing to these potential nutritional consequences, it is important to understand the anatomy of these procedures: three 'limbs' or 'tracts' of intestine are created in a Roux-en-Y procedure: the 'Roux' limb, which is attached to the stomach Evidence-based medicine obesity surgery critique HJ Sugerman and JG Kral and is also known as the 'alimentary tract'; the 'biliopancreatic tract' through which the bile and pancreatic juices drain; and the 'common channel' where food is most efficiently absorbed when mixed with the digestive juices ( Figure 1). In a randomized prospective trial omitted in the TEC report, Brolin and colleagues compared a long-limb gastric bypass with a 35 cm biliopancreatic limb and a 150 cm Roux (alimentary) limb to a standard gastric bypass with a 75 cm Roux limb.…”

“…The TEC report was superficial and incomplete in its review of malabsorptive procedures, omitting relevant articles [101][102][103] and failing to describe accurately the 'longlimb gastric bypass'. 104,105 The TEC report implies that a number of complications are specific to these malabsorptive procedures ('gastric obstruction, leaks at the anastomotic sites and nausea/vomiting caused by the altered stomach physiology', etc), but these complications are seen with equal frequency with all of the other bariatric bypass procedures.…”

Reducing weight increases postural stability in obese and morbid obese men

“…It consisted of 65% distal gastrectomy, gastroenterostomy at 250 cm from the ileocecal valve, and ileoileostomy 100 cm from the ileocecal valve, creating an alimentary chanel of 250 cm including a common chanel of 100 cm. 17,18 The procedure let food go only into the distal intestine, decreases the surface of food absorption and decreases the role of bile. This is a malabsorptive procedure and not a restrictive procedure.…”

Effects of the biliopancreatic diversion on energy balance in the rat

“…The distances used in this surgery, 50 and 20 cm for the alimentary and common limb, respectively, were selected to be representative of the proportions used in human BPD surgery. 10,15 Unlike the human procedure, the duodenum was not transected, for technical reasons. A vertical gastrectomy was performed by excising the entire fibrous membrane of the stomach estimated to be 2/3 of gastric capacity in the rat.…”

“…9,10 Despite the demonstration that bariatric surgery represents an effective approach to treat massively obese patients, 6,7,11 there is as yet no complete understanding of how this surgical procedure affects energy balance. In this study, we adapted the BPD with duodenal switch performed in humans 9,10 to rats in order to assess its effects in the regulation of energy balance. Energy balance measurements including indirect calorimetry and body composition measurements were carried out on all rats.…”