Second-stage robot-assisted biliopancreatic diversion with duodenal switch after sleeve gastrectomy.
Biliopancreatic diversion (BPD) was initially described in 1979 and consisted of a distal gastrectomy with a 250-mL stomach pouch and a distal intestinal bypass with a 50 to 100-cm common channel resulting in malabsorption of dietary fat (Scopinaro et al. Br J Surg. 66(9):618-20, 1979). Later, several modifications (sleeve gastrectomy, pylorus preservation, and duodenal switch) were proposed to improve incidence of postoperative dumping syndrome, diarrhea, and anastomotic ulcerations (Lagacé et al. Obes Surg. 5(4):411-8, 1995). Gagner et al. developed a simplified and reproducible approach for laparoscopic BPD with duodenal switch (BPD-DS) after sleeve gastrectomy (Ren et al. Obes Surg. 10(6): 514-23, 2000). BPD-DS has been considered as one of the most difficult bariatric procedures for its surgical complexity and postoperative metabolic complications management. In this regard, the number of BPD-DS has remained extremely low (<4 %). We hypothesize that robotic approach could facilitate the feasibility of BPD-DS procedure. In this multimedia video (8 min), we present a step-by-step robotic BPD-DS.
Department of Digestive, Hepato-Biliary and Endocrine Surgery, Hopital Brabois Adultes, pole UND, Université de Lorraine-CHU Nancy, Vandoeuvre les Nancy, 54511, France, nannifantola@hotmail.it.
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Fantola
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Reibel
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Germain
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Ayav
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Bresler
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Brunaud
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D015904:Biliopancreatic Diversion / Q000295:instrumentation* / Q000379:methods*; D004377:Dumping Syndrome / Q000209:etiology / Q000517:prevention & control; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D015994:Incidence; D007581:Jejunoileal Bypass / Q000009:adverse effects; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D065287:Robotic Surgical Procedures