Laparoscopic duodenal switch can be the primary option
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Laparoscopic Duodenal Switch Can Be The Primary Option. Olivier Court MD FRCSC Assistant Professor, Department of Surgery Director, Bariatric Surgery McGill University. Disclosure. No affiliations, sponsorships, honoraria, monetary support or conflict of interest from any commercial source.

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Laparoscopic Duodenal Switch Can Be The Primary Option

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Laparoscopic Duodenal Switch Can Be The Primary Option

Olivier Court MD FRCSC

Assistant Professor, Department of Surgery

Director, Bariatric Surgery

McGill University


Disclosure

  • No affiliations, sponsorships, honoraria, monetary support or conflict of interest from any commercial source.


Technique

  • Bougie: 60 Fr

  • Alimentary limb: 150cm

  • Common channel: 100cm

  • Malabsorption

  • Steatorrhea


Benefits of BPD/DS


Weight loss: overall

  • Weight change at 15 years

Marceau et al. Obesity Surg 17;2007:1421-1430


Weight loss: BMI<50

  • 810 patients with BMI<50

  • Reached BMI<35: 92%

  • Reached BMI<30: 71%

Biertho et al. SOARD 6(2010):508-515


Resolution of co-morbidities

  • 810 patients BMI<50 underwent BPD/DS between 1992-2005

  • Resolution of:

    • DM: 92%

    • HTN: 60%

    • OSA: 98%

Biertho et al. SOARD 6(2010):508-515


Resolution of co-morbidities

  • 60 patients with DM randomly assigned to:

    • Medical therapy

    • RNYGB

    • BPD/DS

  • At 2 years follow-up:

  • Mingrone et al. N Engl J Med 366;171577-1585


    Criticisms of BPD/DS


    Perioperative complications

    • 1000 consecutive BPD/DS

    Biertho et al. SOARD (2011)


    Perioperative complications

    • 810 patients with BMI<50

    Biertho et al. SOARD 6(2010):508-515


    Nutritional deficiencies

    • Supplements:

      • Ferrous sulfate: 300mg/day

      • Vitamin D 50,000 UI/day

      • Vitamin A 20,000 UI/day

      • Calcium carbonate 500mg/day

      • Multivitamin

  • Regular bloodwork

    • CBC

    • LFTs

    • Albumin

    • Fe/ferritin

    • Calcum

    • PTH

    • Vitamin A and 1,25 OH Vitamin D


  • Nutritional deficiencies

    Biertho et al. SOARD 6(2010):508-515


    Conclusion

    • Laparoscopic BPD/DS has a number of benefits:

      • Best weight loss of all bariatric procedures

      • Best chance of DM resolution

  • Compared to RNYGB, slightly increased risk of:

    • Anastomotic leak

    • Mortality

    • Nutritional deficiencies, esp. hypoalbuminemia, Vitamin D/Calcium

  • Can be performed safely as a primary procedure provided:

    • Experienced surgeon

    • Highly compliant patient


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