A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional
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B6 Bariatric Times • November 2016 • Supplement B FIRST INTERNATIONAL CONSENSUS CONFERENCE ON DUODENAL SWITCH November 2016 • Supplement B • Bariatric Times I n 1993 Picard Marceau's group published their initial paper titled, "Biliopancreatic diversion with a new type of gastrectomy." 1 Five years later Doug Hess published his first paper on eight- year follow up on patients operated on in Bowling Green, Ohio. 2 Since then, there have been several articles showing the superiority of the duodenal switch (DS)in providing superior weight loss compared with gastric bypass, especially in patients with super- obesity (body mass index [BMI] >50 kg/m 2 ). 3 This has significant pertinence in the United States where the median BMI in many practices is now in the high 40s. 4 The question that then begs an answer is as follows: "If this surgery is so effective at promoting long- term sustained weight loss, particularly in the heavier patient cohort, why does it represent such a small number of the total weight loss procedures done in the US?" (Table 1). 5 The low numbers of biliopancreatic diversion (BPD)/DS may be misleading as some of the revisions and "other" operations may be modifications of this operation (which still does not have a laparoscopic CPT code). It is obvious that there is a perception that the DS operation creates such a significant malabsorption that not only can quality of life be affected • Choosing the right patient is complicated and post-surgical compliance is difficult to asses preoperatively • Consider staging patients for compliance • There are significant postoperative nutrition issues that may increase in consequence over time • Consider concomitant cholecystectomy KEY POINTS Long-term Results of Biliopancreatic Diversion/Duodenal Switch in the United States Alfons Pomp, MD, FACS, FRCSC Bariatric Times. 2016;13(11 Suppl B):B6–B9. AUTHOR AFFILIATIONS: Alfons Pomp, MD, FACS, FRCSC, is Leon C. Hirsch Professor, Vice Chairman, Department of Surgery, Chief, GI Metabolic and Bariatric Surgery, Weill Cornell Medicine in New York, New York. ADDRESS FOR CORRESPONDENCE: Dr. Alfons Pomp, New York Presbyterian Hospital, 525 East 68th Street, Box 294, New York, NY 10065; Phone: 212-746-5294; Fax: 212-746-5236; E-mail: firstname.lastname@example.org FUNDING AND DISCLOSURES: No funding was provided. Dr. Pomp is a consultant/speaker for the following: Medtronic (New Haven, Connecticut), Ethicon (Cincinnati, Ohio), and W. L. Gore and Associates, Inc. (Flagstaff, Arizona). Table 1. American Society for Metabolic and Bariatric Surgery Estimate of Bariatric Surgery Numbers, 2011–2015 2011 2012 2013 2014 2015 Total 158,000 173,000 179,000 193,000 196,000 RNY 36.7% 37.5% 34.2% 26.8% 23.1% Band 35.4% 20.2% 14% 9.5% 5.7% Sleeve 17.8% 33% 42.1% 51.7% 53.8% BPD/DS 0.9% 1% 1% 0.4% 0.6% Revisions 6% 6% 6% 11.5% 13.6% Other 3.2% 2.3% 2.7% 0.1% 3.2% American Society for Metabolic and Bariatric Surgery (ASMBS) total bariatric procedures numbers from 2011, 2012, 2013, 2014, and 2015 are based on the best estimation from available data (BOLD, ASC/MBSAQIP, National Inpatient Sample data and outpatient estimations). The original table included data on balloons (~700 cases) and V-Bloc (18 cases). Reprinted with permission of American Society for Metabolic and Bariatric Surgery, copyright 2015.