Biliopancreatic Diversion: The Effectiveness of Duodenal Switch and Its Limitations

Abstract

The prevalence of morbidly obese individuals is rising rapidly. Being overweight predisposes patients to multiple serious medical comorbidities including type two diabetes (T2DM), hypertension, dyslipidemia, and obstructive sleep apnea. Lifestyle modifications including diet and exercise produce modest weight reduction and bariatric surgery is the only evidence-based intervention with sustainable results. Biliopancreatic diversion (BPD) produces the most significant weight loss with amelioration of many obesity-related comorbidities compared to other bariatric surgeries; however perioperative morbidity and mortality associated with this surgery are not insignificant; additionally long-term complications including undesirable gastrointestinal side effects and metabolic derangements cannot be ignored. The overall quality of evidence in the literature is low with a lack of randomized control trials, a preponderance of uncontrolled series, and small sample sizes in the studies available. Additionally, when assessing remission of comorbidities, definitions are unclear and variable. In this review we explore the pros and cons of BPD, a less well known and perhaps underutilized bariatric procedure.

Early major complications after bariatric surgery in the USA, 2003–2014: a systematic review and meta‐analysis

“…Our study also has several limitations that should be noted. First, we categorized RYGB and BPD/DS into the GB category because of their malabsorptive and restrictive features . Some studies have found that complication rates for BPD/DS were higher than RYGB , while others found comparable complication rates among them .…”

“…Some studies have found that complication rates for BPD/DS were higher than RYGB , while others found comparable complication rates among them . As BPD/DS procedures were performed less common in the USA , the impact of including both RYGB and BPD/DS in the same GB category should be minimal. Upon checking, among the 71 studies included in our meta‐analyses, only three studies included BPD/DS, and after excluding them from the analyses, the complication rates did not vary, except for rates for Leak (from 1.14% to 1.12%) and mortality from PE (from 0.22% to 0.24%).…”

Efficacy of Duodenal Switch Operation in the Management of Diabetes in Morbidly Obese Patients

“…EBWL was reported to reach 69%, 73%, and 66% after 1 year, 3 years, and 5 years of follow-up 25 . Overall, multiple series about BPD/DS have reported 61% to 85% EBWL at moderate term follow-up 26 .…”

“…Other cardiometabolic risk factors, including hypertension and dyslipidemia, have also shown marked improvement following BPD/DS. Additionally, obstructive sleep apnea was resolved in the majority of patients 26 .…”

Laparoscopic Biliopancreatic Diversion with Duodenal Switch - The Most Effective Operation for Type 2 Diabetes Mellitus. How I do it?

“…Type 2 diabetes (T2DM) is the most common form of diabetes, leads to many health problems including cardiovascular disease, stroke, blindness, kidney failure, neuropathy, amputations, impotency, depression, cognitive decline and mortality risk from certain forms of cancer and its prevalence throughout the world has been in direct association increase rates of obesity worldwide (2). Current therapy for type 2 diabetes includes lifestyle intervention (weight-loss, appropriate diet, exercise), anti-diabetes medication(s) or metabolic surgery (3).…”