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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November 2016 • Supplement B • Bariatric Times B25 FIRST INTERNATIONAL CONSENSUS CONFERENCE ON DUODENAL SWITCH T he biliopancreatic diversion with a duodenal switch (BPD-DS) is a less commonly performed but very effective bariatric operation that has been performed for more than 25 years. The original biliopancreatic diversion was described by Scopinaro in 1979. The duodenal switch (DS) version of this operation was first performed by Hess in 1988 but, its first description and outcomes were published by Marceau et al in 1998. 1 Both the BPD and BPD- DS are particularly effective for resolution of diabetes and are associated with highest weight loss compared to other bariatric operations. Key differences exist between the Scopinaro BPD and the BPD-DS. In the BPD, a distal gastrectomy is performed but, in the BPD-DS the pylorus is preserved and a sleeve gastrectomy is performed. On account of these modifications, the BPD-DS is typically not associated with post-gastrectomy symptoms, such as dumping and marginal ulceration. After elongation of the common channel length from 50 cm to a 100 cm for the BPD-DS, Marceau et al compared the results of BPD and BPD-DS from their institution, and reported a decrease in nutritional deficiencies, diarrhea, and reoperation rate (2%) with the BPD-DS. 2 As a result of reduced post-gastrectomy symptoms and improved nutritional outcomes, most surgeons in the North America, practice the BPD-DS. The BPD-DS is a complex operation and until recently was performed mostly by laparotomy and also surgeons worried about its nutritional consequences. More recently, minimally invasive surgery techniques are being utilized with acceptable risk and surgeons are overcoming the learning curve. 3 ,4 In addition to reduction of operative risks, it is very important to understand and manage the nutritional consequences of this operation so that patients are able to derive the benefits of the BPD-DS without suffering from malnutrition, and also appropriately manage malabsorption related side effects, such as diarrhea or foul smelling flatus. In order to reduce the chances of malnutrition, the stomach should have adequate capacity of about 200-250 milliliters. The alimentary limb, measured from the duodeno-ileal anastomosis to the ileocecal valve should be 250 cm and the common channel 100 cm. After the operation, patients should ensure that they are consuming adequate amounts of protein, not consuming too many carbohydrates or fats, and taking water soluble analogues of fat soluble vitamins in addition to other minerals and the water soluble vitamins according to • The biliopancreatic diversion with a duodenal switch (BPD-DS) has been practiced for more than 25 years. It is the most effective operation for weight loss and resolution of diabetes and hypercholesterolemia. • BPD-DS is associated with chances of developing nutritional deficiencies, primarily fat soluble vitamins. • It is very important to 1) understand and manage the nutritional consequences of the BPD-DS so that patients are able to derive the benefits of the operation without suffering from malnutrition, and 2) appropriately manage malabsorption related side effects, such as diarrhea or foul smelling flatus. • To monitor and manage nutritional deficiencies, regular follow up and supplementation with appropriate macro and micronutrients is recommended. KEY POINTS Managing Malnutrition or Other Side Effect of Biliopancreatic Diversion with Duodenal Switch Ranjan Sudan, MD, and Reena Sudan Bariatric Times. 2016;13(11 Suppl B):B25–B29. AUTHOR AFFILIATIONS: Dr. Ranjan Sudan is from Duke University Medical Center, Durham, North Carolina. Reena Sudan is from Duke University, Durham, North Carolina. ADDRESS FOR CORRESPONDENCE: Ranjan Sudan, Box 2834, Duke Medical Center, Durham, NC 27710; Phone: 919-668-3101; Fax: 919-613-5902; E-mail: ranjan.sudan@duke.edu FUNDING AND DISCLOSURES: The authors report no conflicts of interest relevant to the content of this article.