biliopancreatic diversion with duodenal switch

Indications

• morbid obesity; BMI > 40

Procedure

• the greater curvature of the stomach is resected
• the 1st segment of the duodenum is divided
• the proximal duodenum & 1/2 of the small intestine is excluded from the flow of digestive material
• the small intestine is divided 300 cm above the ileocecal junction, & the distal end anastomosed to the first portion of the duodenum
• the distal end of the excluded segment is anastomosed to the ileum 50-100 cm proximal to the ileocecal junction; the proximal end is sealed; pancreatic & biliary secretions flow through this segment into the ileum

Complications

• adverse effects in 80% of patients
• malnutrition-related events
  • night blindness (vitamin A deficiency)
  • severe iron deficiency
  • protein calorie malnutrition

Notes

• greater weight loss than gastric bypass (74 vs 51 kg)
  • BMI decrease of 22 vs 14
• greater reduction in LDL cholesterol than gastric bypass
• more adverse events than gastric bypass (62 vs 32%)
  • more hospital admission (60% vs 30%)
  • additional surgical procedures (45% vs 10%)

More general terms

• bariatric surgery