A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional
Issue link: http://bariatrictimes.epubxp.com/i/749808
B4 Bariatric Times • November 2016 • Supplement B FIRST INTERNATIONAL CONSENSUS CONFERENCE ON DUODENAL SWITCH T he 1 st International Consensus Conference on Duodenal Switch (ICCDS-1) was held in Quebec City, at the Quebec City Convention Centre, May 27 to 28, 2016. This conference is the logical consequence of five similar conferences on sleeve gastrectomy (SG) held in New York City in 2007, Miami Beach in 2009, and again in NYC in 2010 and 2012, and during IFSO 2014 in Montreal. After 15 years of good results from the sleeve gastrectomy (often perceived as the first stage of a complete duodenal switch [DS]), it was time to assess the role of DS in two stages: weight regain after sleeve gastrectomy and newer variants of the procedure such as SADI (Single Anastomosis Duodeno- Ileostomy) or SIPS (Stomach Intestinal Pyloric Sparing surgery). This meeting stretched over two days, with eight live surgeries from multiple operating rooms from four different countries (United States, Belgium, Spain, and Canada), followed by oral presentations on various subjects touching this intervention. There were more than 100 participants from 22 countries. Here, eight selected authors present summaries of their presentations, which were chosen among the most influential during ICCDS-1. Although the percentage of biliopancreatic diversion (BPD) and DS (often combined in the same category) over the total number of bariatric procedures has decreased (from 4.8% in 2003 to 1.5% in 2013), 1,2 this phenomenon is hiding three important facts. First, the number of pure BPD or "Scopinaro" procedures has plummeted and are virtually abandoned in several parts of the world, except perhaps in a few pockets of Italy. Second, the absolute numbers of DS worldwide are in constant progression (Total of BPD + DS from 7,081 in 2003 to 7,163 in 2013), 2 which means that either surgeons have changed the BPD to DS and/or newer surgeons doing SG are now learning the complete procedure. According to a recent world survey (2013) 2 the total number of DS have doubled in a decade to more than 6,000 (25% were performed in North America, and 50% in Latin America), a number quite close to a new popular single anastomosis gastric bypass (8,000). Third, the viral success of SG has delayed the progression of DS because most DS surgeons are now doing the procedure in two parts. Hence, this consensus conference took place at the most appropriate time; when weight regain is presented in many SG patients (especially in patients with super- obesity). This year, live surgeries performed by various expert surgeons consisted of procedures for either a technique or for revision/conversions. In the technical camp, we have observed and commented on a SADI from Dr. Andre Sanchez-Pernaute (Madrid, Spain), a classic laparoscopic DS from Dr. Laurent Biertho (Quebec City, Quebec, Canada), a SIPS Stomach Intestinal Pyloric Sparing surgery with mesenteric defect closure from Dr. Daniel Cottam (Salt Lake City, Utah), and a robotic DS by Dr. Gintaras Antanavicius (Abington, Pennsylvania). Concerning revisions/conversions, we saw and commented on a re-sleeve gastrectomy from Dr. Guy-Bernard Cadiere (Brussels, Belgium), a sleeve to SADI from Dr. Andres Sanchez-Pernaute, a sleeve to SIPS from Dr. Mitchell Roslin (New York, New York) and a revisional DS by Dr. Laurent Biertho. This whole day was complemented by videos of technical tips, complications, and revisions presented by Drs. Frédéric-Simon Hould (Quebec City, Quebec, Canada), Vivek Prachand (Chicago, Illinois), Francois Julien (Quebec City, Quebec, Canada), Giovanni Dapri (Brussels, Belgium), Andre Teixeira (Orlando, Florida), Sergio Santoro (Sao Paulo, Brazil), Michel Gagner (Montreal, Quebec, Canada), Fernando Bonanni (Abington, Pennsylvania.), and Antonio Torres. The second day, the morning of oral presentations was dedicated to nutrition, physiology of hypo- absorption, and hormonal aspects. For those topics, we requested Drs. Dominique Garrel (Montreal, Quebec, Canada), Frederic Hould, Ranjan Sudan (Durham, North Carolina), and Maud Robert (Lyon, France). We then had a session on outcomes and Director's Message Michel Gagner, MD, FRCSC, FACS, FASMBS Clinical Professor of Surgery, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida and Senior Consultant, Department of Surgery, Hopital du Sacre Coeur, Montreal, Quebec, Canada.