Duodenal switch: Technique and outcomes

Abstract

The biliopancreatic diversion with duodenal switch (BPD/DS) procedure is the most effective bariatric procedure for achieving maximal and long-standing weight loss. Furthermore, this is the most effective treatment for metabolic syndrome comorbidities. Nevertheless, the traditional BPD/DS procedure is technically challenging and carries significantly higher morbidity and mortality compared to other bariatric procedures such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). In addition, nutritional derangements are more common and require aggressive supplementation and long-term follow-up. Nevertheless, in properly selected patients with appropriate patient education, BPD/DS can be highly effective with minimal morbidity. Variations of this procedure have emerged to mitigate perioperative morbidity and long-term nutritional deficiencies, without significantly compromising the weight loss and metabolic syndrome reduction properties. The two most commonly performed variations include the single-anastomosis duodeno-ileal bypass (SADI) and stomach intestinal pylorus-sparing (SIPS) surgery. The following chapter will discuss the role of the BPD/DS procedure in morbidly obese patients, as both a weight loss procedure and a metabolic procedure. Furthermore, a comparison to the newer modifications, the SADI and SIPS procedure, will be undertaken.