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Duodenal Switch and Its Derivatives in Bariatric and Metabolic Surgery
AComprehensive Clinical Guide
Andre Teixeira· Muhammad A. Jawad· Manoel dos Passos Galvão Neto· Antonio Torres· Laurent Biertho· João Caetano Marchesini· Erik Wilson Editors
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Duodenal Switch and Its Derivatives in Bariatric and Metabolic Surgery
Andre Teixeira • Muhammad A. Jawad Manoel dos Passos GalvãoNeto 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 GalvãoNeto 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, specically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microlms 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 specic 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 afliations.
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 modied 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 reux 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).
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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, difculty to be performed, less expe­rienced bariatric surgeons adequately trained, submission to a longer learning curve, time-consuming operation, low patient appeal, more difcult 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 modications.
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 benets. 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 modications 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
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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 JoãoB.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-dened, 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 18months to be completed and was by far one of the most dif­culty 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 AndreTeixeira Orlando, FL, USA MuhammadA.Jawad Indore, Madhya Pradesh, India Manoeldos PassosGalvãoNeto Madrid, Spain AntonioTorres Quebec, QC, Canada LaurentBiertho Curitiba, Paraná, Brazil JoãoCaetanoMarchesini Bellaire, TX, USA ErikWilson
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 scientic 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
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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
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