Duodenal Switch for Morbid Obesity

A series of articles about Duodenal Switch for Morbid Obesity
(BMI > 40).

Outcome of laparoscopic duodenal switch for morbid obesity.

Magee et al. Oct 2010

PubMed Abstract

BACKGROUND: The aim of this study was to determine the safety
and efficacy of laparoscopic duodenal switch (LDS) as a treatment
option in a selected group of patients with morbid obesity.

METHODS: This retrospective analysis of a prospective database
assessed the frequency of all complications and alterations
in weight, body mass index (BMI), co-morbidity and quality
of life.

RESULTS: One hundred and twenty-one patients underwent LDS
between April 2003 and March 2009. Median preoperative weight
was 160 kg and median BMI 55 kg/m(2). All procedures were
performed laparoscopically. The in-hospital mortality rate
was zero. No ileoduodenal anastomotic stenosis was encountered.
There were four clinical leaks (3·3 per cent) managed by
laparoscopic drainage and placement of a feeding jejunostomy.
Median percentage excess weight loss was 75 per cent at 12
months and 90 per cent at 24 months. Thirty-six of 40 diabetic
patients had complete resolution of diabetes within 1 year.
There were significant improvements in other obesity-related
co-morbidity. Only a few patients developed postoperative
protein deficiency, and fat-soluble vitamin deficiencies
were easily managed with oral supplementation.

CONCLUSION: The LDS procedure is a safe and effective treatment
for morbid obesity and its associated co-morbidity in selected

Is biliopancreatic diversion with duodenal switch indicated
for patients with body mass index <50 kg/m(2)?

Marceau et al. Sept 2010

PubMed Abstract

BACKGROUND: Biliopancreatic diversion with duodenal switch
(DS) has been the standard surgical approach for the treatment
of morbidly obese patients at our institution since the early
1990s. The published data, however, have shown the use of the
DS to be limited to the treatment of super-morbidly obese
patients (body mass index [BMI] >/=50 kg/m(2)). The aim of
the present study was to present our long-term results with
the DS in patients with an initial BMI of <50 kg/m(2).

METHODS: This was a retrospective study of all patients with
a BMI <50 kg/m(2) who had undergone DS from June 1992 to May
2005. The data are reported as the mean +/- standard deviation.

RESULTS: The data from 810 consecutive patients, with a mean
initial BMI of 44.2 +/- 3.6 kg/m(2), were reviewed. The mean
follow-up was 103 +/- 49 months. Major perioperative complications
occurred in 5.8% of patients, including 5 deaths (.6%). The initial
excess weight loss was 76% +/- 22%, and the excess weight loss
was >50% in 89% of patients. Malnutrition required readmission
in 4.3% and surgical revision in 1.5%. The prevalence of severe
albumin deficiency (<30 g/L) was 1.1%, hemoglobin deficiency
(<100 g/L), 1.6%, iron deficiency (<4 mmol/L) 2.1%, and calcium
deficiency (<2 g/L) 3%. The percentage of patients “very satisfied”
with the global result was 91%, and 37% would have preferred
to lose more weight.

CONCLUSION: These results showed that in non super-obese patients,
DS was very efficient in terms of weight loss and patient satisfaction.
This was associated with a 1.5% risk of revision for malnutrition.
However, nutritional deficiencies required frequent readjustment
of supplements, particularly for calcium, vitamin A, and vitamin D.

The Duodenal Switch Operation for Morbid Obesity

Anthone Aug 2005

PubMed Abstract

The duodenal switch provides excellent weight loss with preservation
of good alimentation, even in the superobese. This is accomplished
with acceptable operative mortality and minimal dietary limitations
and metabolic sequelae. The results of the duodenal switch that are
reported in the literature should remove any inhibitions that exist
about the use of this procedure as treatment for patients who have
morbid obesity. This article discusses the duodenal switch operation
for morbid obesity.

The Duodenal Switch as an Increasing and Highly Effective
Operation for Morbid Obesity

Rabkin et al. June 2004

PubMed Abstract

Full Article

INTRODUCTION: “Morbid Obesity” (ICD 278.01 / BMI >40) is an
entity distinct from “obesity”, the latter term encompassing
the broad range of over weight. Available treatment modalities
as well as outcomes differ substantially over the spectrum of
higher BMI. Representative data for behavior modification,
diet and exercise show at best an average weight loss of 4-7
kg at 2 years, with decreasing benefit in the longer term.

The reported maximum of 7 kg is hardly significant for a morbidly
obese individual who might be carrying an excess weight 45-75 kg
or more. Those morbidly obese patients who do respond to non-surgical
weight loss programs, generally fail to maintain the weight loss,
with recidivism rates exceeding 95%. Behavior modification, diet
and exercise have been found to be ineffective on an intermediate
and long-term basis for treatment of obesity, particularly morbid
obesity. Regain of the lost weight is the rule, and more than the
initial weight lost is commonly regained.

Surgery is the only modality proven to be effective in the
treatment of morbid obesity; however, surgical treatment
entails known finite risks influenced by clinical factors.
To achieve a beneficial net reduction in morbidity and mortality,
the risks from the excess weight must exceed the risks of
surgery and anesthesia. It is interesting to note that published
series show significant increases in the relative risk associated
with obesity at a BMI of 27 kg/m2, and exponential increases at
a BMI of 32 kg/m2 (the highest bracket reported) – well below
the 35 to 40 kg/m2 often considered minimum for surgical

Duodenal Switch: An Effective Therapy for Morbid Obesity –
Intermediate Results

Baltasar et al. April 2002

PubMed Abstract

BACKGROUND: The duodenal switch (DS) is a variant of the
biliopancreatic diversion (BPD), with a verticalsubtotal
gastrectomy and pylorus preservation.

METHODS: DS was used to treat morbid obesity in 125 patients,
with mean BMI 50, with 65% of thepatients super obese (SO).
Patients have been followed for an intermediate period.

RESULTS: The percentage of excess weight loss (%EWL) was >
70% at 1 year, and reached 81.4% at 5years when 97% of the
patients had a %EWL > 50%. Comorbidities were cured or improved
in allpatients.

CONCLUSION: DS was very effective for the treatment of the
morbid obesity in the SO patients.

Biliopancreatic Diversion with a Duodenal Switch

Hess et al. June 1998

PubMed Abstract

BACKGROUND: This paper evaluates biliopancreatic diversion
combined with the duodenal switch, forming a hybrid procedure
which is a combination of restriction and malabsorption.

METHODS: The evaluation is of the first 440 patients undergoing
this procedure who had had no previous bariatric surgery. The
mean starting weight was 183 kg, with 41% of our patients
considered super morbidly obese (BMI > 50).

RESULTS: There was an average maximum weight loss of 80%
excess weight by 24 months postoperation; this continued
at a 70% level for 8 years. Major complications were found
in almost 9% of the cases. There were two perioperative deaths,
one from pulmonary embolism and one from acute pulmonary
obstruction. There were 36 type II diabetics, all of whom
have discontinued medication following the surgery. Seventeen
revisions were performed to correct excess weight loss and
low protein levels. There have been no marginal ulcers, no
cases of dumping syndrome, no foreign material used, and
the procedure is a pyloric saving procedure which is functionally

CONCLUSIONS: This operation has vastly improved the lives of
seriously obese patients with many comorbidities. All type
II diabetics have essentially been cured of their disease.
The procedure was tolerated well and patients are quite satisfied.
There was minimal regain of weight with this method.