Metabolic Duodenal Switch: The Old is New again
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Keywords:
Duodenal switch
Biliopancreatic Diversion
Excess weight
Jejuno-ileal bypass (JIB) was introduced in the 1950s. Roux-en-Y gastric bypass (RYGBP) was introduced in the 1960s and gastroplasty (GP) in the 1970s, and then we returned to RYGBP in the 1980s, because GP was noted to have a relatively poor record with long-term maintained weight loss. Also in the 1980s, biliopancreatic diversion (BPD; the Scopinara procedure) was introduced, along with the modification biliopancreatic diversion-duodenal switch (BPD-DS), which came along a few years later in the late 1980s and 1990s. Also in the 1990s, laparoscopy began to flourish, the adjustable gastric band came on the scene, and it soon became apparent that RYGBP and BPD-DS could also be done in this fashion. What to do? This is a study of a series of over 2400 primary RYGBPs done by a single surgeon from 1986 to March 2003, which was preceded by a 7-year experience with various type gastroplasty procedures. Major complications requiring re-operations were less than 2%, and the mortality rate was 0.3%. Mean excess weight loss at 10 years averaged 62%, which compares well with other studies. There are many operative choices in bariatric surgery, which allows us to individualize each patient's needs. However, open RYGBP seems to be a reasonable, if not the best, compromise for the vast majority of patients considering relative risks, benefits, and favorable outcomes. The pros and cons of each approach and the reason for this surgeon's conclusions will be discussed.
Biliopancreatic Diversion
Duodenal switch
Adjustable gastric band
Excess weight
Gastric banding
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Citations (23)
Biliopancreatic Diversion
Duodenal switch
Excess weight
Sleeve gastrectomy
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Biliopancreatic Diversion
Duodenal switch
Excess weight
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Citations (19)
Duodenal switch
Biliopancreatic Diversion
Adjustable gastric band
Sleeve gastrectomy
Excess weight
Cite
Citations (29)
Duodenal switch
Biliopancreatic Diversion
Excess weight
Adjustable gastric band
Sleeve gastrectomy
Gastric banding
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Citations (42)
Biliopancreatic Diversion
Duodenal switch
Excess weight
Cite
Citations (18)
Background: Interest in the quality of life (QoL) of patients with morbid obesity continues to grow. Weight loss has been shown to improve QoL in obese persons undergoing a variety of treatments, but there is little data available comparing different surgical procedures and QoL questionnaires. Methods: In 133 patients, four different questionnaires where applied: the SF-12v2 (short form of SF-36), the BAROS (Bariatric Analysis and Reporting Outcome System), the GIQLI (Gastrointestinal Quality of Life Index) and the BQL (Bariatric Quality of Life Score). These patients underwent laparoscopic gastric banding (LAGB; n = 55), laparoscopic Roux-en-Y gastric bypass (RYGB; n = 49), biliopancreatic diversion with duodenal switch (BDP-DS; n = 23), or vertical banded gastric bypass (VBGB). All these procedures where performed in one bariatric center in Germany. Results: In all groups, QoL scores and excess weight loss (EWL) improved considerably, but EWL was clearly higher in BPD-DS and RYGB patients (62 and 60%) as compared to LAGB cases (47%). Similarly, standardized 1-year BQL scores were better for BPD-DS and RYGB (76 and 80%) than for LAGB (71%). Furthermore, weight changes over time seemed to reach a plateau phase in the LAGB patients, whereas BPD-DS led to continuing weight loss. Discussion: Although all procedures are effective, our data show important differences between the different procedures. Since weight loss after LAGB is smaller and less progressive, smaller improvements in QoL can be expected although the risk of complications is less. This should be borne in mind when selecting the type of surgery.
Biliopancreatic Diversion
Duodenal switch
Excess weight
Roux-en-Y anastomosis
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Duodenal switch
Biliopancreatic Diversion
Sleeve gastrectomy
Excess weight
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Duodenal switch
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Adjustable gastric band
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Excess weight
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Duodenal switch
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Excess weight
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