Einstein (São Paulo) (Mar 2006)
Biliopancreatic bypass with longitudinal gastrectomy and piloric preservation ("Duoderal Switch")
Abstract
The bilio-pancreatic diversion with duodenal switch is amodification of the Scopinaro’s operation that is gaining spacein bariatric surgery. Its configuration aims the diminution of thebilio-pancreatic diversion side effects. Either by laparotomy orlaparoscopy, a sleeve gastrectomy is performed. The duodenumis partitioned close to the pancreatic plateau. The distal stumpis closed. The ileum is partitioned between 200 and 300cmfrom the cecum and the distal ending is anastomosed to theduodenum. The proximal ending is anastomosed to the ileumfrom 50 to 100cm of the cecum. The related excess weightloss is 75%. It is maintained for long periods when shorteralimentary and common limbs are used. Common limbs lengthsfixed of 100cm may be related to long term weight regain. Comorbiditiessuch as diabetes and dislipidemia obtained highrates of resolution. Protein malnutrition, excessive weight loss,anemia related to iron deficit and secondary hyperparathyroidismwere the main long term complications. Hormonal mechanismsare associated to the benefic effects of the operation for diabeticsubjects. The sleeve gastrectomy leads to early satiety. Theselective lipid malabsorption acts in the improvement of thehypercholesterolemia. The operation produces great resultsregarding weight loss and control of co-morbidities. Itminimizes the side effects of the Scopinaro operation. It maylead to metabolic and nutritional disorders.
