Laparoscopic biliopancreatic diversion with duodenal switch: three different duodeno-ileal anastomotic techniques and initial experience.
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.


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.


CONCLUSIONS
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.
Weiner
R A
RA
Department of Surgery, Krankenhaus Sachenhausen, Schulstrasse 31, Frankfurt am Main, Germany. rweiner@khs-ffm.de
Blanco-Engert
R
R
Weiner
S
S
Pomhoff
I
I
Schramm
M
M
D000328:Adult; D000714:Anastomosis, Surgical; D015904:Biliopancreatic Diversion / Q000379:methods*; D004386:Duodenum / Q000601:surgery; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D013536:Suture Techniques; D016896:Treatment Outcome