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  • Title: Laparoscopic biliopancreatic diversion with duodenal switch: three different duodeno-ileal anastomotic techniques and initial experience.
    Author: Weiner RA, Blanco-Engert R, Weiner S, Pomhoff I, Schramm M.
    Journal: Obes Surg; 2004 Mar; 14(3):334-40. PubMed ID: 15072654.
    Abstract:
    BACKGROUND: The duodenal switch (DS) is a variant of the biliopancreatic diversion (BPD) for surgical treatment of morbid obesity. Absence of dumping syndrome leads to a high quality of life in these patients. The complexity of the laparoscopic BPD-DS is high, and the technical aspects of the duodeno-ileostomy are still under consideration. MATERIALS AND METHODS: Laparoscopic BPD-DS is described, with early surgical outcomes of 63 patients reported. We used 3 different techniques for creation of the duodeno-ileostomy, which were compared. RESULTS: 2 staple-line leaks at the gastric sleeve and 1 anastomotic leak after circular stapling of the duodeno-ileostomy occurred. In the same patient with the leak, a marginal ulcer was registered 4 months after surgery. There were no differences in the operating-time between the 3 groups. The combined linear stapled and totally hand-sewn anastomosis were the safest methods to perform the duodeno-ileostomy. Local wound infection at a trocar site (insertion of the circular stapler) was the most common local complication, occurring in 3 patients after using the circular stapling technique only. Postoperative stay was 4 to 8 days, except for the 3 patients with complications. CONCLUSION: Laparoscopic BPD-DS is an advanced, complex and feasible technique in bariatric surgery. The combined linear stapled and total hand-sewn anastomosis are not only the technically easiest procedures to perform, but also appear to be the safest techniques.
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