Duodenal switch in revisional bariatric surgery: conclusions from an expert consensus panel |
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| Institution: | 1. Department of General Surgery, Banner University Medical Center–Phoenix, University of Arizona, Phoenix, Arizona;2. Institute for Obesity and Metabolic Disorders, Banner University Medical Center–Phoenix, University of Arizona, Phoenix, Arizona;3. Herbert Wertheim School of Medicine, Florida International University, Miami, Florida;4. Hôpital du Sacre Coeur, Montreal, Quebec, Canada;5. Department of Surgery, Complutense University of Madrid, Hospital Clinico “San Carlos,” Madrid, Spain;6. The European School of Laparoscopic Surgery, Brussels, Belgium;7. Fresno Medical Education Program, University of California San Francisco, Fresno, California;8. Minimally Invasive and Bariatric Surgery, Fresno Heart and Surgical Hospital, Fresno, California;9. Department of General Surgery, Cleveland Clinic, Weston, Florida;10. Division of General/Bariatric Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina;1. St Luke''s University Hospital and Health Network, Lewis Katz School of Medicine at Temple University, Allentown, Pennsylvania;2. Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina;1. Columbia University College of Physicians and Surgeons at Harlem Hospital, New York, New York;2. Wyckoff Heights Medical Center, Brooklyn, New York;1. Vanderbilt University Medical Center, Nashville, Tennessee;2. Bon Secours General Surgery at St Mary’s Hospital, Richmond, Virginia;3. Cleveland Clinic, Cleveland, Ohio;4. Swedish Medical Center, Seattle, Washington;5. Cleveland Clinic Florida, Weston, Florida;6. Stanford School of Medicine, Stanford, California;1. Emirates Specialty Hospital, Dubai, United Arab Emirates;2. ELSAN, Clinique Saint Michel, Centre Chirurgical de l''Obesite, Toulon, France;3. ELSAN, Clinique Bouchard, Marseille, France;4. Sacre Cœur Hospital, Montreal, Canada;1. Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada;2. Wexner Medical Center, The Ohio State University, Columbus, Ohio;1. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin;2. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;3. William S. Middleton VA Hospital, Madison, Wisconsin |
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| Abstract: | BackgroundDuodenal switch (BPD/DS) is gaining popularity as a secondary procedure for inadequate weight loss after an initial operation.ObjectivesWe aimed to generate expert consensus points on the appropriate use of BPD/DS in the revisional bariatric surgical setting.SettingData were gathered at an international conference with attendees from a variety of different institutions and settings.MethodsSixteen lines of questioning regarding revisional BPD/DS were presented to an expert panel of 29 bariatric surgeons. Current available literature was reviewed extensively for each topic and proposed to the panel before polling. Responses were collected and topics defined as achieving consensus (≥70% agreement) or no consensus (<70% agreement).ResultsConsensus was present in 10 of 16 lines of questioning, with several key points most prominent.ConclusionsAs a second-stage procedure, BPD/DS is most appropriate after sleeve gastrectomy (SG) for the treatment of super morbid obesity (96.7% agree) or as a subsequent operation for a reliable patient with insufficient weight loss after SG (88.5%). In a patient with weight regain and reflux and/or enlarged fundus after SG, Roux-en-Y gastric bypass is preferable and BPD/DS should be avoided (90%). BPD/DS should not be used prophylactically in patients with a history of jejunoileal bypass who are otherwise doing well (80.8%). Applicability of BPD/DS is limited by technical difficulty; 86.2% of experts would routinely recommend or consider the procedure if it were more technically feasible after failed bypass. No consensus was found on approaches to revision of BPD/DS for protein malnutrition. |
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| Keywords: | Obesity Duodenal switch Revisional bariatric surgery Expert consensus |
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