Atlas de imágenes Laparoscópicas del Cruce Duodenal (parte I) <span class="so-article-trans-title" dir="auto"> Translated title: Laparoscopic Imaging Atlas of the Duodenal Switch (part I) </span>

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Abstract

Resumen La Derivación Bilio-Pancreática laparoscópica (DBP) con Cruce Duodenal (CD) es una operación técnicamente desafiante que requiere una extensa disección quirúrgica, transección y restauración de la continuidad intestinal, y habilidades avanzadas de sutura laparoscópica.

Translated abstract

Abstract Laparoscopic Bilio-Pancreatic Diversion (BPD) with Duodenal Switch (CD) is a technically challenging operation that requires extensive surgical dissection, transection and restoration of bowel continuity, and advanced laparoscopic suturing skills.

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Most cited references 8

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Biliopancreatic diversion with a duodenal switch.

Stephen Hess (1998)

This paper evaluates biliopancreatic diversion combined with the duodenal switch, forming a hybrid procedure which is a combination of restriction and malabsorption. The evaluation is of the first 440 patients undergoing this procedure who had had no previous bariatric surgery. The mean starting weight was 183 kg, with 41% of our patients considered super morbidly obese (BMI > 50). There was an average maximum weight loss of 80% excess weight by 24 months postoperation; this continued at a 70% level for 8 years. Major complications were found in almost 9% of the cases. There were two perioperative deaths, one from pulmonary embolism and one from acute pulmonary obstruction. There were 36 type II diabetics, all of whom have discontinued medication following the surgery. Seventeen revisions were performed to correct excess weight loss and low protein levels. There have been no marginal ulcers, no cases of dumping syndrome, no foreign material used, and the procedure is a pyloric saving procedure which is functionally reversible. This operation has vastly improved the lives of seriously obese patients with many comorbidities. All type II diabetics have essentially been cured of their disease. The procedure was tolerated well and patients are quite satisfied. There was minimal regain of weight with this method.

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Early results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients.

C J Ren, E Patterson, M Gagner (2000)

Biliopancreatic diversion with duodenal switch (BPD-DS) is an operation which provides one of the greatest maintained weight losses of any bariatric procedure. We looked at the safety and efficacy of laparoscopic BPD-DS for morbid obesity. A 150-200 ml sleeve gastrectomy was created and anastomosed to the distal 250 cm of divided ileum. The median length of the common channel was 100 cm. All patients were prospectively followed up to 12 months. 40 consecutive patients underwent laparoscopic BPD-DS as a primary procedure for morbid obesity. Median patient body mass index (BMI) was 60 kg/m2 (range 42-85 kg/m2). Mean age was 43 +/- 1 years (+/- SEM), with 12 males and 28 females. One patient was converted to open laparotomy (2.5%). Median operative time was 210 +/- 9 minutes (range 110-360 minutes) with a significant correlation between BMI and operative time (p = 0.04). Median length of stay was 4 days (range 3-210 days). There was one 30-day mortality (2.5%). Major morbidities occurred in 6 patients (15%), including 1 anastomotic leak (2.5%), 1 venous thrombosis (2.5%), 4 staple-line hemorrhages (10%) and 1 subphrenic abscess (2.5%). Median follow-up at 6 months (range 1-12 months) resulted in 46% +/- 2% excess weight loss (EWL) and at 9 months 58% +/- 3% EWL. Laparoscopic BPD-DS is a complex, yet feasible, procedure resulting in effective weight loss with an acceptable morbidity. A BMI >65 was associated with increased morbidity and mortality. A long-term study is needed to confirm efficacy and proper patient selection.