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Duodenal Switch and Its
Derivatives in Bariatric
and Metabolic Surgery
AComprehensive Clinical
Guide
Andre Teixeira· Muhammad
A. Jawad· Manoel dos Passos
Galvão Neto· Antonio
Torres· Laurent Biertho· João
Caetano Marchesini· Erik
Wilson Editors
123

Duodenal Switch and Its Derivatives in Bariatric
and Metabolic Surgery

Andre Teixeira • Muhammad A. Jawad
Manoel dos Passos GalvãoNeto
Antonio Torres • Laurent Biertho
João Caetano Marchesini • Erik Wilson
Editors
Duodenal Switch and Its
Derivatives in Bariatric and
Metabolic Surgery
A Comprehensive Clinical Guide

Editors
Andre Teixeira
Bariatric Surgery Department
Orlando Health
Orlando, FL, USA
Muhammad A. Jawad
Bariatric Surgery Department
Orlando Health
Orlando, FL, USA
Manoel dos Passos GalvãoNeto
Bariatric Endoscopy
Mohak Bariatric and Robotic Center at Sri
Aurobindo Medical College
Indore, Madhya Pradesh, India
Antonio Torres
Medical School, Universidad Complutense
de Madrid (UCM); IdISSC
Hospital Clínico San Carlos; Complutense
University
Madrid, Madrid, Spain
Laurent Biertho
Bariatric and general surgery
Quebec Heart and Lung Institute, Laval
University
Quebec, QC, Canada
João Caetano Marchesini
Bariatric Surgery
Clínica Caetano Marchesini
Curitiba, Paraná, Brazil
Erik Wilson
Div of Surgery, Minimally Invasive
The University of Texas Health Science C
Bellaire, TX, USA
ISBN 978-3-031-25827-5 ISBN 978-3-031-25828-2 (eBook)
https://doi.org/10.1007/978-3-031-25828-2
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2023
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way, and
transmission or information storage and retrieval, electronic adaptation, computer software, or by similar
or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specic statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Foreword
Christian Albert Theodor Billroth would have never thought that gastrectomy and
gastrojejunal anastomosis, one day, would establish the major pillars for metabolic
and bariatric surgery.
Bypassing the duodenum and adding early offer of the gastric content to distal
small bowel promote, through several different mechanisms, early satiety, hunger
control, and increased energy expenditure. This condition causes, consequently,
sustained weight loss and control or a resolution of associated diseases.
Soon after the use of the Billroth II technique, some complications were observed.
One of them was inadvertent gastroileal anastomosis, which resulted in malnutrition
and severe weight loss.
Nicola Scopinaro, based on such complications, proposed a new operation called
biliopancreatic diversion. It was a distal gastrectomy with gastroileal anastomosis in
a Roux-en-Y fashion.
Douglas Hess and Piccard Marceau modied Scopinaro’s operation. Instead of
doing a distal gastrectomy, they performed a vertical sleeve gastrectomy with pylorus and part of the duodenal bulb preservation. The anastomosis of this pyloroduodenal end was also done with the ileum in a Roux-en-Y manner.
This was the birth of the duodenal switch.
How was this new operation named?
Hess and Marceau borrowed the name of an operation proposed by Tom
DeMeester as a treatment for duodeno-gastric reux and alkaline gastritis.
Duodenal switch has been the root of some other bariatric operations such as
sleeve gastrectomy, single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI’S), gastric plication, endoscopic gastric plication among several others.
SADI’S also have several variations or at least several different names such as
single anastomosis duodenojejunal bypass with sleeve gastrectomy (SADJB-SG),
stomach intestinal pyloric sparing surgery (SIPS), one anastomosis duodenal switch
(OADS), loop duodenojejunal bypass with sleeve gastrectomy (LDJB-SG), distal
loop duodeno-ileostomy (DIOS) and proximal duodeno-jejunostomy (DJOS).
v

vi
Foreword
All efforts have been done to improve the nal results of these procedures.
Despite being the most effective operation to control hunger and satiety and to
promote sustainable weight loss, unfortunately, nutritional complications have been
the major reason for its low application.
The number of duodenal switches remains low worldwide, even though, they
keep showing the best results for weight loss, lasting effect, and reversal of
comorbidities.
Besides nutritional issues, some other reasons may contribute to its low
application.
Higher laparoscopic technical complexity, difculty to be performed, less experienced bariatric surgeons adequately trained, submission to a longer learning curve,
time-consuming operation, low patient appeal, more difcult follow-up, inadequate
patient choice for this operation, surgical risks, and side effects may explain the low
number of duodenal switches performed and published in the medical literature.
Once malnutrition is controlled the bariatric and metabolic results justify increasing the numbers of duodenal switches and/or their modications.
I have learned from my own experience of more than two decades and above 700
patients operated upon that there is an ideal patient for the original duodenal switch.
Even though the indication is based on BMI over 40 with or without comorbidities, super obese patients and those with metabolic syndrome have the best benets.
Patients that eat more fatty foods have better results compared to the ones that eat
more starch. Economic conditions also make difference. They need to afford continuous use of Vitamins, Minerals, and other supplements. Patients that are not kept
on track may develop complications. Follow-up is very important. The patient needs
to understand the surgery to cooperate during the long postoperative period.
All modications that duodenal switch suffered during these years look after the
necessity to protect the patients from malnutrition consequences.
We need to look forward to having these side effects better controlled to offer our
bariatric and metabolic patients the best solution for their disease.
Duodenal Switch and Its Derivatives in Bariatric and Metabolic Surgery: A
Comprehensive Clinical Guide comes now to up-to-date studies on this particular
eld of bariatric and metabolic surgery.
This publication joins the most important and most experienced metabolic and
bariatric surgeons in the world as well as associated experts. Here, they present their
experiences, their opinions, and their indispensable teaching.
This publication covers all elds of metabolic and bariatric surgery related to
duodenal switches and similar operations.

Foreword
vii
Starting with an anatomical review and physiologic principles, it is followed by
types of derivative operations, advantages and disadvantages, complications, revisional procedures, nutritional matters, and many other issues. It is a complete book
on this subject.
I believe it will help all metabolic and bariatric surgeons and associated professionals to offer to these patients what exists as the best for this very important eld
of medicine.
Enjoy the reading.
University of Parana JoãoB.Marchesini,
Curitiba, Paraná, Brazil

Preface
Obesity is a major cause of disability and is correlated with various diseases and
conditions particularly cardiovascular diseases, type 2 diabetes, obstructive sleep
apnea, certain types of cancer, and osteoarthritis. High BMI is a marker of risk for,
but not a direct cause of, diseases caused by diet and physical activity.
Obesity has individual, socioeconomic, and environmental causes. Some of the
known causes are diet, physical activity, automation, urbanization, genetic susceptibility, medications, mental disorders, economic policies, endocrine disorders, and
exposure to endocrine-disrupting chemicals.
Although there is no effective, well-dened, evidence-based intervention for preventing obesity, obesity prevention will require a complex approach, including
interventions at community, family, and individual levels.
The initial idea for this book came around October 2020 and by December 2022
we had a rough draft of the editors and the main authors for the chapters. The initial
chapter index had 37 chapters and rapidly grew to 72, we settled for 67 chapters.
The project took 18months to be completed and was by far one of the most difculty projects to be completed due to the sheer volume of chapters, in the midst of
Covid 19 ravaging through our lives.
The goal of this book is to be used as the main source of information and learning
techniques on duodenal switches in metabolic and bariatric surgery. We recruited
authors that are heavily involved in the care of patients that are going through the
process or already have a duodenal switch procedure done.
Orlando, FL, USA AndreTeixeira
Orlando, FL, USA MuhammadA.Jawad
Indore, Madhya Pradesh, India Manoeldos PassosGalvãoNeto
Madrid, Spain AntonioTorres
Quebec, QC, Canada LaurentBiertho
Curitiba, Paraná, Brazil JoãoCaetanoMarchesini
Bellaire, TX, USA ErikWilson
ix

Acknowledgments
I would like to acknowledge the amazing team composed by Vanessa Shimabukuro
and Prakash Jagannathan that have made this book possible by keeping me and the
other editors on track. I could not also acknowledge all the authors that have contributed to this amazing scientic contribution for bariatric and metabolic surgery.
The most important acknowledgment is to my wife Maria and my son Enzo for
their amazing support and understanding for the countless hours that were devoted
to this project until its completion.
Andre Teixeira MD, FACS, FASMBS
xi

Contents
Part I Introduction
1 A Brief History of the Duodenal Switch . . . . . . . . . . . . . . . . . . . . . . . . 3
Jacques M. Himpens
2 Duodenal Switch: Mechanisms of Functioning . . . . . . . . . . . . . . . . . . 17
Andrés Sánchez-Pernaute, Miguel Ángel Rubio Herrera,
and María Elia Pérez Aguirre
3 Duodenal Switch and Its Derivatives . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Yen-Yi Juo and Ranjan Sudan
4 Primary Single Anastomosis Duodenal Switch: Perspective
from a Lengthy Experience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Mitchell Roslin, Michael Marchese, Daniyal Abbs, and Donna
Bahroloomi
5 Duodenal Switch and Its Derivatives in Bariatric
and Metabolic Surgery
Joseph A. Sujka, Christopher G. DuCoin, and Nathan Zundel
Part II Weight Loss Surgery
6 Pathophysiology of the Cardiometabolic Alterations in Obesity . . . . 69
Frédérique Proulx, Giada Ostinelli, Laurent Biertho,
and André Tchernof
7 Pathophysiology of Bile Acid Regulation . . . . . . . . . . . . . . . . . . . . . . . 85
Joseph A. Sujka and Christopher G. DuCoin
8 Nonalcoholic Steatohepatitis (NASH) . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Gustavo Marino, Ibrahim M. Zeini, and Muhammad Ghanem
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
xiii
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