title: Laparoscopic biliopancreatic diversion with a duodenal switch for morbid obesity: a feasibility study in pigs.
abstract: OBJECTIVE
  Biliopancreatic diversion with a duodenal switch is an emerging open procedure that appears as effective as other bariatric operations. Our goal was to determine the safety and feasibility of performing this procedure using a laparoscopic approach in a porcine model.
  
  
  METHODS
  Six 50-kg pigs underwent surgery. Intake was restricted with a sleeve gastrectomy, and malabsorption was obtained by creating a Roux-en-Y. The Roux limb served as a 150-cm alimentary channel following anastomosis to a transected proximal duodenum, while the other limb, or biliopancreatic channel, transported digestive juices. Where the two limbs joined, a 100-cm common channel was formed.
  
  
  RESULTS
  The operation was completed in a mean time of 4.5 hours. Two of the six pigs had an intraoperative duodenoenterostomy anastomotic leak detected on methylene blue testing. This leakage was thought to be related to pig anatomy and is not expected to be a problem in humans. At necropsy, all anastomoses were patent, and there were no enteroenterostomy leaks or mesenteric torsions.
  
  
  CONCLUSIONS
  On the basis of the porcine model, laparoscopic biliopancreatic diversion with a duodenal switch is anticipated to be feasible and safe in humans. Substantial weight loss combined with the benefits of laparoscopic surgery can be expected.
authors.affiliation: Division of Laparoscopic Surgery, Mount Sinai School of Medicine, New York, New York, USA.
authors.forename: J
authors.initials: J
authors.lastname: de Csepel
authors.forename: S
authors.initials: S
authors.lastname: Burpee
authors.forename: G
authors.initials: G
authors.lastname: Jossart
authors.forename: V
authors.initials: V
authors.lastname: Andrei
authors.forename: Y
authors.initials: Y
authors.lastname: Murakami
authors.forename: S
authors.initials: S
authors.lastname: Benavides
authors.forename: M
authors.initials: M
authors.lastname: Gagner
mesh_terms: D000713:Anastomosis, Roux-en-Y; D000818:Animals; D015904:Biliopancreatic Diversion / Q000379:methods*; D004195:Disease Models, Animal; D004386:Duodenum / Q000601:surgery*; D005240:Feasibility Studies; D005743:Gastrectomy; D010535:Laparoscopy; D009767:Obesity, Morbid / Q000601:surgery*; D013552:Swine