Alexa E Merz1, Robin B Blackstone2, Michel Gagner3, Antonio J Torres4, Jacques Himpens5, Kelvin D Higa6, Raul J Rosenthal7, Aaron Lloyd8, Eric J DeMaria9. 1. Department of General Surgery, Banner University Medical Center-Phoenix, University of Arizona, Phoenix, Arizona. Electronic address: aemerz@gmail.com. 2. Institute for Obesity and Metabolic Disorders, Banner University Medical Center-Phoenix, University of Arizona, Phoenix, Arizona. 3. Herbert Wertheim School of Medicine, Florida International University, Miami, Florida; Hôpital du Sacre Coeur, Montreal, Quebec, Canada. 4. Department of Surgery, Complutense University of Madrid, Hospital Clinico "San Carlos," Madrid, Spain. 5. The European School of Laparoscopic Surgery, Brussels, Belgium. 6. Fresno Medical Education Program, University of California San Francisco, Fresno, California; Minimally Invasive and Bariatric Surgery, Fresno Heart and Surgical Hospital, Fresno, California. 7. Department of General Surgery, Cleveland Clinic, Weston, Florida. 8. Minimally Invasive and Bariatric Surgery, Fresno Heart and Surgical Hospital, Fresno, California. 9. Division of General/Bariatric Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina.
Abstract
BACKGROUND: Duodenal switch (BPD/DS) is gaining popularity as a secondary procedure for inadequate weight loss after an initial operation. OBJECTIVES: We aimed to generate expert consensus points on the appropriate use of BPD/DS in the revisional bariatric surgical setting. SETTING: Data were gathered at an international conference with attendees from a variety of different institutions and settings. METHODS: Sixteen lines of questioning regarding revisional BPD/DS were presented to an expert panel of 29 bariatric surgeons. Current available literature was reviewed extensively for each topic and proposed to the panel before polling. Responses were collected and topics defined as achieving consensus (≥70% agreement) or no consensus (<70% agreement). RESULTS: Consensus was present in 10 of 16 lines of questioning, with several key points most prominent. CONCLUSIONS: As a second-stage procedure, BPD/DS is most appropriate after sleeve gastrectomy (SG) for the treatment of super morbid obesity (96.7% agree) or as a subsequent operation for a reliable patient with insufficient weight loss after SG (88.5%). In a patient with weight regain and reflux and/or enlarged fundus after SG, Roux-en-Y gastric bypass is preferable and BPD/DS should be avoided (90%). BPD/DS should not be used prophylactically in patients with a history of jejunoileal bypass who are otherwise doing well (80.8%). Applicability of BPD/DS is limited by technical difficulty; 86.2% of experts would routinely recommend or consider the procedure if it were more technically feasible after failed bypass. No consensus was found on approaches to revision of BPD/DS for protein malnutrition.
BACKGROUND: Duodenal switch (BPD/DS) is gaining popularity as a secondary procedure for inadequate weight loss after an initial operation. OBJECTIVES: We aimed to generate expert consensus points on the appropriate use of BPD/DS in the revisional bariatric surgical setting. SETTING: Data were gathered at an international conference with attendees from a variety of different institutions and settings. METHODS: Sixteen lines of questioning regarding revisional BPD/DS were presented to an expert panel of 29 bariatric surgeons. Current available literature was reviewed extensively for each topic and proposed to the panel before polling. Responses were collected and topics defined as achieving consensus (≥70% agreement) or no consensus (<70% agreement). RESULTS: Consensus was present in 10 of 16 lines of questioning, with several key points most prominent. CONCLUSIONS: As a second-stage procedure, BPD/DS is most appropriate after sleeve gastrectomy (SG) for the treatment of super morbid obesity (96.7% agree) or as a subsequent operation for a reliable patient with insufficient weight loss after SG (88.5%). In a patient with weight regain and reflux and/or enlarged fundus after SG, Roux-en-Y gastric bypass is preferable and BPD/DS should be avoided (90%). BPD/DS should not be used prophylactically in patients with a history of jejunoileal bypass who are otherwise doing well (80.8%). Applicability of BPD/DS is limited by technical difficulty; 86.2% of experts would routinely recommend or consider the procedure if it were more technically feasible after failed bypass. No consensus was found on approaches to revision of BPD/DS for protein malnutrition.
Authors: Conor Brosnan; Jarlath C Bolger; Eamonn M Bolger; Michael E Kelly; Roisin Tully; Mohamed AlAzzawi; William B Robb Journal: Obes Surg Date: 2020-08-21 Impact factor: 4.129