Duodenal Switch and Its Derivatives in Bariatric and Metabolic Surgery: A Comprehensive Clinical Guide

Foreword
Preface
Acknowledgments
Contents
Part I: Introduction
Chapter 1: A Brief History of the Duodenal Switch
1.1 History
1.2 The Initiator: Scopinaro
1.3 The Pioneers: Hess and Marceau
1.4 The Laparoscopic DS (Gagner) and the Idea of Staging
1.5 Clinical Outcomes
1.6 New Developments: The Loop-DS
References
Chapter 2: Duodenal Switch: Mechanisms of Functioning
2.1 Introduction
2.2 The Sleeve Gastrectomy
2.3 Pyloric Preservation
2.4 Biliopancreatic Diversion
2.5 Conclusion
References
Chapter 3: Duodenal Switch and Its Derivatives
3.1 Introduction
3.2 History
3.3 Derivative Procedures of Duodenal Switch
3.4 Pre-operative Consideration
3.4.1 Indications for Surgery
3.4.2 Contraindications
3.5 Procedural Details
3.5.1 Patient Positioning and Port Placement
3.5.2 Laparoscopic Portion
3.5.3 Cholecystectomy
3.5.4 Sleeve Gastrectomy
3.5.5 Duodenal Dissection and Duodeno-Ileostomy
3.5.6 Ileo-Ileal Anastomosis
3.5.7 Mesentery Defect Closures
3.6 Post-operative Care
3.7 Complications
3.8 Outcomes
3.9 BPD-DS as Revisional Surgery for Weight Regain
3.10 Summary
References
Chapter 4: Primary Single Anastomosis Duodenal Switch: Perspective from a Lengthy Experience
4.1 Historical Perspective of Weight Loss Procedures
4.2 The Next Frontier
4.3 To Treat Obesity, It Is Necessary to Understand the Cause
4.4 The Next Domain: Glucose Variability and Matching Bariatric Surgery to Modern Obesity Treatment
4.5 Rationalization for Patient Selection
4.6 SADI/SADS vs. Traditional Roux DS
4.7 SADS vs. RYGB
4.8 SADS vs. OAGB (One Anastomosis Gastric Bypass)
4.9 Surgical Technique
4.10 Issues in Complication Management
4.11 Malnutrition: Input and Output Issues
4.12 Electrolyte and Micronutrient Deficiencies
4.13 Fat Soluble Vitamins
4.14 Vitamin B12
4.15 Trace Elements
4.16 Metabolic Bone Disease
4.17 Nephrolithiasis
4.18 SADS Surgical Correction for Malabsorption
4.19 Additional Complications of SADS: Gastroesophageal Reflux Disease (GERD)
4.20 Conclusion
References
Chapter 5: Duodenal Switch and Its Derivatives in Bariatric and Metabolic Surgery
5.1 Introduction
5.2 Preoperative Workup
5.3 Techniques and Derivatives of BPD/DS
5.4 Post-operative Care
5.5 Complications
5.6 Outcomes
5.7 Conclusion
References
Part II: Weight Loss Surgery
Chapter 6: Pathophysiology of the Cardiometabolic Alterations in Obesity
6.1 Introduction
6.2 Body Fat Distribution and Excess Accumulation of Visceral Adipose Tissue
6.3 Pathophysiology of the Cardiometabolic Alterations in Obesity: Adipose Tissue Dysfunction
6.4 Cardiometabolic Alterations Associated with Visceral Obesity
6.5 Reversal of Metabolic Dysfunction After Bariatric Surgery
6.6 Conclusions
References
Chapter 7: Pathophysiology of Bile Acid Regulation
7.1 Introduction
7.2 Physiology of Bile Acid
7.3 Pathophysiology of Bile Acid Regulation
7.3.1 Receptors and Signaling
7.3.2 Obesity, Bariatric Surgery, and Diabetes
7.3.3 Non-alcoholic Fatty Liver Disease and Non-alcoholic Steatohepatitis
7.4 Conclusion
References
Chapter 8: Nonalcoholic Steatohepatitis (NASH)
8.1 Introduction
8.2 Epidemiology
8.3 Pathogenesis
8.4 Clinical Manifestations
8.4.1 Diagnosis
8.5 Treatment
8.6 Medication
References
Chapter 9: Patient Selection
9.1 Potential Candidates for Duodenal Switch
9.2 Selection Algorithms
9.3 Contraindications for Duodenal Switch
9.4 Duodenal Switch as a Staged Procedure
9.5 Duodenal Switch as a Rescue for Failed Primary Procedure
References
Chapter 10: Psychological and Psychiatric Workup
10.1 Introduction
10.2 Important Psychological Aspects on the Evaluation and Follow-Up of Candidates for Bariatric Surgery
10.3 Important Psychiatric Aspects on the Evaluation and Follow-Up of Candidates for Bariatric Surgery
10.4 Impulsivity and Compulsivity
10.5 Binge Eating Disorder
10.6 Night Eating Syndrome
10.7 Emotional Eating
10.8 Food Addiction
10.9 Grazing
10.10 Addiction Transfer After Bariatric Surgery
10.11 Final Considerations
References
Chapter 11: Nutritional, Behavioral, and Support for Duodenal Switch
11.1 Introduction
11.2 Nutritional Pre-optimization and ERABS
11.2.1 Pre-optimization (Pre-habilitation)
11.2.2 Optimizing Nutrition Status
11.2.3 Pre-operative Weight Loss and Nutrition Counseling
11.2.4 Liver-Shrinking Diet and ERABS
11.2.5 Pre-operative Information and Counseling
11.3 Potential Nutrition Complications
11.4 Encouraging Dietary Behavioral Changes
11.5 Conclusion
References
Chapter 12: Preoperative Endoscopy
12.1 Introduction
12.2 Role of Esophagogastroduodenoscopy Prior to Bariatric and Metabolic Surgery Procedures
12.2.1 Abnormal Findings
12.2.2 Testing and Treatment of H. pylori
References
Chapter 13: Postoperative Care
13.1 Introduction
13.2 Multidisciplinary Team
13.3 Postoperative Unit
13.4 Analgesia
13.5 Diet
13.6 Thromboprophylaxis
13.7 Investigations
13.8 Adjustments of Comorbidity Treatments
13.9 Antihypertensive Medication
13.10 Dyslipidemia Medication
13.11 Diabetic Medication
13.12 Contraceptive Counselling
13.13 Vitamins
13.14 Length of Stay
References
Chapter 14: Preoperative Testing and Counseling
14.1 Introduction
14.2 History
14.3 Laboratory Testing
14.4 Psychosocial Evaluation
14.5 GI Evaluation
14.6 VTE/Deep Venou Thrombosis (DVT)
14.7 Cholelithiasis/Abdominal US
14.8 Medical Subspecialty Evaluation
14.8.1 Pulmonary
14.8.2 Cardiology
14.8.3 Endocrinology
14.9 Informed Consent
14.10 Conclusion
References
Chapter 15: Risk Assessment and Reduction
15.1 Risk Assessment
15.2 Risk Reduction
15.2.1 Smoking
15.2.2 Substance Abuse
15.2.3 Psychosocial Evaluation
15.2.4 Cardiopulmonary Assessment
15.2.5 Chronic Steroid Immunosuppression
15.2.6 Preoperative Weight Loss and Liver Volume Reduction
15.2.7 Hospital and Programmatic Support of Bariatric Surgery
References
Chapter 16: Airway Evaluation and Management
16.1 Obstructive Sleep Apnea History and Management
16.2 Possible Difficult Laryngoscopy
16.3 Possible Difficult Mask
References
Chapter 17: Patient Positioning and Positioning for Bariatric Surgery
17.1 General Considerations for Patient Positioning
17.2 Considerations for Selected Positions and Changes in Physiology
17.2.1 Supine
17.2.2 Semi-fowler/fowler’s
17.2.3 Lithotomy
17.2.4 Lateral Decubitus
17.2.5 Robotic Surgery
17.3 Summary
References
Chapter 18: Intraoperative Monitoring of the Morbidly Obese Patient
18.1 Pulse Oximetry
18.2 Electrocardiogram
18.3 Blood Pressure
18.4 Arterial Line
18.5 End Tidal Carbon Dioxide Monitoring
18.6 Temperature
18.7 Additional Monitors
18.7.1 Noninvasive Cardiac Output Monitors
18.7.2 Processed Electroencephalogram
References
Chapter 19: Method of Anesthesia: Gas Selection and Adjunct Medications
19.1 Definition of Morbid Obesity
19.2 Why It Is Important to Dose Inhalational Agents and Other Drugs Differently in Obese Patients
19.3 Anesthesia Gases Used for Bariatric Surgery
19.4 Drug Dosing for Obese Patients
19.5 Emergence from Inhalational Anesthesia
19.5.1 Adjunct Medications
References
Further Reading
Chapter 20: Regional Anesthesia in Bariatric Surgery
20.1 Introduction
20.2 Regional Block
20.3 Transversus Abdominal Plane Block (TAP Block)
20.3.1 Outcomes
20.3.2 Erector Spinae Plane Block (ESPB)
20.4 Conclusion
References
Chapter 21: Multimodal Analgesia in Bariatric Surgery
21.1 Introduction
21.2 Opiates
21.3 Acetaminophen
21.4 Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
21.5 N-Methyl-D-Aspartate Antagonists
21.6 Alpha-2 Agonists
21.7 Calcium Channel Blocker
21.8 Lidocaine Patches
21.9 Tramadol
21.10 Local Anesthetic Wound Infiltration and Infusions
21.11 Conclusion
References
Chapter 22: Anatomical Considerations
22.1 Introduction
22.2 Sleeve Gastrectomy
22.3 Duodenal Approach
22.4 Jejunum and Ileum
22.5 Summary
References
Chapter 23: Robotic Duodenal Switch and SADI-S: Technical Aspects
23.1 Introduction
23.2 Biliopancreatic Diversion with Duodenal Switch
23.2.1 Patient Positioning and Port Placement
23.2.2 Duodenal Dissection
23.2.3 Sleeve Gastrectomy
23.2.4 Duodeno-Ileostomy
23.2.5 Ileoileostomy
23.2.6 Hernia Defects
23.2.7 Anastomotic/Staple Line Leak Test
23.3 Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy
23.4 Conclusion
References
Chapter 24: Laparoscopic Biliopancreatic Diversion with Duodenal Switch: Surgical Technique
24.1 Introduction
24.2 Surgical Technique (Video 24.1)
24.2.1 Preoperative Evaluation
24.2.2 Preparation and Patient Positioning
24.2.3 Peritoneal Access and Ports Positioning
24.2.4 Gastric Mobilization
24.2.5 Duodenal Dissection
24.2.6 Sleeve Gastrectomy
24.3 Small Bowel Measurement and Transection
24.3.1 Duodenoileostomy
24.3.2 Ileoileostomy
24.4 Closure of Mesenteric Window and Petersen Window
24.5 Postoperative Care
24.6 Conclusion
References
Chapter 25: SADIS: Technical Details
25.1 Introduction
25.2 Surgical Technique
25.2.1 Patient Preparation
25.2.2 Position of the Patient and the Surgical Team
25.2.3 Trocar Position
25.2.4 Procedure
25.2.4.1 Sleeve Gastrectomy and Duodenal Dissection
25.2.4.2 Duodeno-Ileal Bypass
25.3 Postoperative Course
25.4 Technical Pitfalls
25.5 Technical Advantages of SADI-S
25.6 Conclusions
References
Chapter 26: Technical Aspects of Single Anastomosis Duodenal Switch: SIPS Version
References
Chapter 27: Duodenal Bipartition or Side-to-Side Duodeno-Ileostomy: Rationale and Technical Details
27.1 Rationale
27.2 Technique
References
Chapter 28: Duodeno-Ileal Anastomosis with Hand-Sewn Technique
28.1 Introduction
28.2 Surgical Technique
28.3 Potential Points of Discussion
References
Chapter 29: Circular Anastomosis in Duodenal Switch
29.1 Introduction
29.2 Circular Mechanic Duodeno-Ileal Anastomosis
29.3 Technical Issues
29.4 Technical Variations of the Circular Anastomosis
29.5 Points of Discussion
29.6 Summary
References
Chapter 30: Duodenoileal Anastomosis with Linear Stapler Technique
30.1 Introduction
30.2 Procedural Approach
30.2.1 Common Limb Measurement
30.2.2 Duodenal Dissection
30.2.3 Duodenoileal Anastomosis
References
Chapter 31: Staged Duodenal Switch for High-Risk Patients
31.1 Introduction
31.2 Procedure
31.3 Stage 1: Sleeve Gastrectomy
31.4 Stage 2: Duodenoileostomy and Ileoileostomy
31.4.1 Duodenal Transection
31.4.2 Alimentary Limb Creation
31.4.3 Duodenoileostomy
31.4.4 Ileoileostomy
31.4.5 Robotic-Assisted Laparoscopic BPD/DS
31.5 High-Risk Classification Leading to Staging
31.6 Postoperative Care
31.7 Indications
31.8 Contraindications
31.9 Complications
31.9.1 Surgical
31.9.2 Nutritional
31.10 Outcomes
31.11 Conclusions
References
Chapter 32: Duodenal Switch, SADI, and SIPS in Adolescent
References
Chapter 33: Duodenal Switch (DS), Single Anastomosis Duodeno-Ileal Bypass (SADI) and Stomach Intestinal Pylorus-Sparing Surgery (SIPS) in the Elderly
33.1 Introduction
33.2 Obesity and Age
33.3 Bariatric Surgery in the Elderly
33.4 Choice of Bariatric Procedure in the Elderly
33.5 Preoperative Assessment, Anaesthesia and Perioperative Care in Elderly Patients
33.6 Surgical Technique
33.7 Postoperative Management: Enhanced Recovery
33.8 Long-Term Results
References
Chapter 34: Right Gastric Artery Ligation: The Brazilian Results
References
Chapter 35: Surgery Failure: What Are the Options?
35.1 Introduction
35.2 Prevalence of Failure
35.3 Reasons for Failure
35.3.1 Patient Comorbidities
35.3.2 Psychological Conditions
35.3.3 Physiologic/Anatomic Reasons
35.3.4 Lack of Support
35.3.5 Noncompliance with Lifestyle Changes
35.4 Patient Assessment
35.5 Options Following Failure
35.5.1 Medical Options
35.5.2 Surgical Options
35.6 Conclusions
References
Chapter 36: Causes of Weight Regain After Duodenal Switch and Its Derivatives
36.1 Introduction
36.2 Long-Term Outcomes of Duodenal Switch and Derivatives
36.2.1 Classic DS
36.2.2 Single Anastomosis DS Derivatives
36.3 Weight Regain After Duodenal Switch and Derivatives
36.3.1 Classic DS
36.3.2 Single Anastomosis DS Derivatives
36.4 Causes of Weight Regain
36.4.1 Lifestyle and Patient-Related Factors
36.4.2 Surgery-Related Factors
36.5 Summary
References
Chapter 37: Revisional Surgery for Weight Regain
37.1 Introduction
37.2 Incidence and Causes of Weight Regain
37.3 Definition of Weight Regain
37.4 Preoperative Evaluation
37.5 Selecting the Type of Revisional Surgery
37.5.1 Adjustable Gastric Band
37.5.2 Non-adjustable Band/Vertical Banded Gastroplasty
37.5.3 Roux-En-Y Gastric Bypass
37.5.4 Sleeve Gastrectomy
37.5.5 Biliopancreatic Diversion With or Without Duodenal Switch
37.6 Role and Impact of Duodenal Switch
37.7 Weight Loss Following Revisional Surgery
37.8 Complications of Revisional Surgery
37.9 Conclusion
References
Chapter 38: Conversion of Sleeve Gastrectomy to Duodenal Switch and SADI-S
38.1 Introduction
38.2 Weight Loss Failure After SG
38.3 Reoperative Procedures for Failure in Weight Control After Sleeve
38.4 Conversion of SG to BPD-DS and SADI-S: Surgical Technique
38.5 Results of Conversion from SG into BPD-DS or SADI-S/OADS
38.6 Summary
References
Chapter 39: Gastric Band Revision to Duodenal Switch
39.1 Introduction
39.2 Materials and Methods
39.3 Preoperative Preparation
39.4 Surgical Technique
39.5 Results
References
Chapter 40: Endoscopic Treatment of Weight Regain in Duodenal Switch
40.1 Introduction
40.2 Conclusion
References
Chapter 41: Conversion of Gastric Bypass to Duodenal Switch
41.1 Introduction
41.2 Gastric Bypass Failure
41.3 Surgical Options
41.4 Surgical Treatment
41.4.1 Part 1: Gastrogastrostomy Creation
41.4.2 Part 2: Sleeve Gastrectomy
41.4.3 Part 3: Reversal of Jejunojejunostomy
41.4.4 Part 4: Duodenoileostomy Creation
41.4.5 Part 5: Ileoileostomy Creation
41.4.6 Part 6: Surgery Completion
41.5 Postoperative Care
41.6 One Stage Vs. Two Stage
41.7 Traditional Vs. Single Anastomosis
41.8 Results
41.9 Conclusions
References
Chapter 42: Management of Duodenal Stump Blowout
42.1 Introduction
42.2 Presentation of Stump Blowout
42.3 Diagnosis of a Blowout
42.4 General Management of a Stump Blowout
42.5 Conservative Management
42.6 Percutaneous Approach
42.7 Surgical Management
42.8 Special Considerations in Duodenal Switch
42.9 Conclusion
References
Chapter 43: Duodenoileal Anastomosis Testing
43.1 Introduction
43.2 Methylene Blue Test (Fig. 43.3)
43.3 Water-Air Leak Test (Fig. 43.1a and b)
43.4 Intraoperative Endoscopic Direct Visualization
43.5 Indocyanine Green Test and Combination of Blend and Endovascular Test (Fig. 43.2a and b)
References
Chapter 44: Closing the Mesenteric Defects
44.1 Introduction
44.2 Experience from the Roux-en-Y Gastric Bypass
44.3 Experience in Duodenal Switch/Derivatives
44.4 Closure Techniques
44.5 Ileo-ileostomy Defect (See Video 44.1)
44.6 Petersen Defect (See Video 44.2)
44.7 Tips and Tricks
44.8 Summary
References
Chapter 45: Preventing Surgical Complications
45.1 Preoperative Prevention
45.2 Intraoperative Techniques
45.3 Postoperative Care
45.4 Conclusion
References
Chapter 46: Malabsorptive Complications
46.1 Introduction
46.2 Long-Term and Nutritional Complications
46.2.1 Anatomic Effects on Nutrition
46.2.2 Hypoproteinemia
46.2.3 Chronic Diarrhea
46.2.4 Electrolyte Repletion and Refeeding Syndrome
46.2.5 Micronutrient Considerations
46.2.5.1 Vitamin A
46.2.5.2 Calcium and Vitamin D
46.2.5.3 Folic Acid
46.2.5.4 Zinc
46.2.5.5 Iron
46.2.6 Metabolic Bone Disease
46.2.7 Nephrolithiasis
46.3 Conclusion
References
Chapter 47: Postoperative Psychological Assistance
47.1 Introduction
47.2 Cognitive Behavioral Therapy (CBT)
47.3 Interpersonal Psychotherapy (IPT) for Obesity
47.4 Mindfulness
47.5 ER-Based Methods
47.6 Final Considerations
References
Chapter 48: Surgical Management of Leaks
48.1 Introduction
48.2 Early Surgical Management
48.3 Leak from the Sleeve
48.4 Leak from the Duodenoileostomy
48.5 Leak from the Duodenal Stump
48.6 Leak from the Jejunoileostomy
References
Chapter 49: Internal Hernias and Bowell Obstruction
49.1 Introduction
49.2 Discussion
49.3 Conclusion
References
Chapter 50: Management of Portal Vein Thrombosis Following Bariatric Surgery
50.1 Introduction
50.2 Presentation
50.3 Diagnosis: Imaging and Laboratory Testing
50.4 Prophylactic Anticoagulation Following Bariatric Surgery
50.5 Treatment of Venous Thromboembolism in Obese Patients and After Bariatric Surgery
50.6 Management of Portal Vein Thrombosis After Bariatric Surgery
50.7 Conclusion
References
Chapter 51: Gallstones and Choledocholithiasis
51.1 Introduction
51.1.1 Cholelithiasis
51.1.2 Choledocolithiasis
51.2 ERCP in Patients with Surgically Altered Anatomy
51.3 Transgastric and Transenteric ERCP Assisted by Laparoscopy
51.4 Final Considerations
References
Chapter 52: Hyperinsulinemic Postprandial Hypoglycemia After Duodenal Switch
52.1 Introduction
52.2 Etiology
52.3 Diagnosis
52.4 Treatment
52.5 Case Report and Reversal of Duodenal Switch into Normal Anatomy with Sleeve Gastrectomy (Fig. 52.1; See Video 52.1)
52.6 Conclusions
References
Chapter 53: Diarrhea After Duodenal Switch: Medical and Surgical Management
53.1 Diarrhea
53.2 Pathophysiology of Duodenal Switch and Diarrhea
53.2.1 Evaluation of Diarrhea
53.2.1.1 History
53.2.2 Physical Exam
53.2.3 Testing
53.3 General Management of Diarrhea
53.3.1 Medical Management of Diarrhea Related to Nutrient Malabsorption
53.3.2 Patient Education
53.3.2.1 Surgical Treatment of Diarrhea
References
Chapter 54: Endoscopic Treatment of Complications
54.1 Introduction
54.2 Major Approaches on the Duodenal Switch
54.2.1 General Information: Duodenal Switch
54.2.2 Major Complications
54.2.2.1 Leak
54.2.2.2 Endoscopic Treatment
54.2.2.3 Blocking Methods: Self-Expanding Metal Prosthesis
54.2.3 Internal Drainage Methods
54.2.3.1 Septotomy with Dilation
54.2.3.2 Internal Drainage with Pigtail Drain
54.2.3.3 Vacuum Endoscopic Therapy
54.2.3.4 Hemorrhage
54.3 Final Considerations
References
Chapter 55: Global Analysis of Our Experience with Hypoabsorptive Technique: >500 Cases DS vs. SADI-S
55.1 Introduction
55.1.1 How We Do It
55.1.2 Our Register
55.1.3 Statistical Analysis
55.1.4 Our Experience
55.2 Discussion
55.3 Conclusions
References
Chapter 56: Body Contouring After Duodenal Switch
56.1 Introduction
56.2 Preoperative Evaluation and Planning
56.2.1 Weight History
56.2.2 Body Mass Index (BMI)
56.2.3 Nutritional Assessment
56.2.4 Medical, Surgical, and Social History
56.2.5 Insurance Coverage
56.2.6 Venous Thromboembolism (VTE)
56.3 Surgical Procedures
56.3.1 Staging
56.3.2 Upper Body
56.3.2.1 Arm
56.3.2.2 Back
56.3.2.3 Chest (Male)
56.3.2.4 Breast (Female)
56.3.3 Lower Body
56.3.3.1 Abdomen/Buttocks
56.3.3.2 Thigh
56.4 Complications
56.5 Outcomes
56.5.1 Quality of Life
56.6 Conclusion
References
Chapter 57: Bariatric Surgery Population in the ICU
57.1 Obesity Definitions
57.2 ICU Admission Criteria
57.3 The Respiratory System
57.4 The Cardiovascular System
57.5 The Renal System
57.6 Pharmacology in the ICU
57.7 Assessing Caloric Needs in the Critically Ill Obese Patient
57.8 Nutrition in the Post-bariatric Surgery Patient
57.9 Deep Venous Thrombosis Prophylaxis
57.10 The Obesity Paradox in Critical Care
57.11 Nursing Care of the Obese ICU Patient
References
Chapter 58: Bariatric Emergencies for the General Surgeon
58.1 Implantable Devices
58.2 Gastrointestinal Bleed
58.2.1 Leak
58.2.2 Perforation
58.2.3 Small Bowel Obstructions
58.2.4 Stenosis and Volvulus
58.3 Conclusions
References
Chapter 59: Robotic Bariatric Surgeon Training
59.1 Introduction
59.2 Simulation Training
59.3 Learning Curve and Training Curricula in Bariatric Robotic Surgery
59.4 Stages of Training in the da Vinci® System
References
Part III: Metabolic and Diabetes Type 2 Surgery
Chapter 60: Mechanisms of Control of Diabetes 2 with Duodenal Switch
60.1 Introduction
60.2 Risk Factors
60.3 Bariatric Surgery and DM2
60.4 Mechanisms for DM2 Control
60.4.1 Decreased Caloric Intake
60.4.2 Weight Loss
60.4.3 Malabsorption
60.4.4 Duodenal/Jejunal Bypass
60.5 Conclusions
References
Chapter 61: The Evolution of Single-Anastomosis Duodenal Switch
61.1 Introduction
61.1.1 The Journey to the Duodenal Switch
61.1.2 The Initiation of the Single-Anastomosis Duodenal Switch
61.1.3 Ever-Evolving Variations
61.2 Conclusions
References
Chapter 62: Chapters on Metabolic Syndrome Control and the Influence of Hormonal Changes Post-duodenal Switch (DS)
62.1 The Hormonal Changes After a Duodenal Switch and Their Potential Mechanisms
62.1.1 Reductions in Food Intake
62.1.2 Mechanical Factors
62.1.3 Malabsorption
62.1.4 Hypothalamic Signalling
62.1.5 Gut Hormones and Leptin
62.1.5.1 Glucagon-Like Peptide-1 (GLP-1)
62.1.5.2 Oxyntomodulin (OXM)
62.1.5.3 Peptide YY (PYY)
62.1.5.4 Ghrelin
62.1.5.5 Leptin
62.1.6 Vagal Signalling
62.1.7 Bile Acids
62.1.8 Gut Microbiota
62.2 The Impact of DS on the Complications of Obesity
62.2.1 What are the Metabolic Issues Caused by Obesity and How Do They Change After DS?
62.2.1.1 Airway
62.2.1.2 BMI Reduction
62.2.1.3 Cardiovascular Disease
Hypertension
62.2.1.4 Diabetes Mellitus
62.2.1.5 Economic
62.2.1.6 Functional
62.2.1.7 Gonadal
62.2.1.8 Health Status Perceived QoL
62.2.1.9 Image
62.2.1.10 Junction of the Gastroesophagus
62.2.1.11 Kidney
62.2.1.12 Liver: Nonalcoholic Fatty Liver Disease (NAFLD)
62.3 Glycaemic Control and Diet in Patients Undergoing Bariatric Surgery
62.4 Pre-operative Glycaemic Management of the Patient with Diabetes Undergoing Bariatric Surgery
62.5 Psychologic Support Pre-operatively
62.6 Dietician Support Pre-operatively
References
Chapter 63: Staged Duodenal Switch for High-Risk Patients
63.1 Introduction
63.2 Procedure
63.2.1 Stage 1: Sleeve Gastrectomy
63.2.2 Stage 2: Duodenoileostomy and Ileoileostomy
63.2.2.1 Duodenal Transection
63.2.2.2 Alimentary Limb Creation
63.2.2.3 Duodenoileostomy
63.2.2.4 Ileoileostomy
63.2.2.5 Robotic-Assisted Laparoscopic BPD/DS
63.3 High-Risk Classification Leading to Staging
63.3.1 Postoperative Care
63.3.2 Indications
63.3.3 Contraindications
63.3.4 Complications
63.3.4.1 Surgical
63.3.4.2 Nutritional
63.3.5 Outcomes
63.4 Conclusions
References
Chapter 64: Duodenal Switch in Patients with Metabolic Syndrome
64.1 Introduction
64.2 Hormones Impacted by Bariatric Surgery
64.2.1 Leptin
64.2.2 Ghrelin
64.2.3 Incretins
64.2.4 Polypeptide YY
64.3 Metabolic Syndrome and the Duodenal Switch
64.3.1 Weight Loss
64.3.2 Diabetes and Pre-diabetes
64.3.2.1 “Gastric Hypothesis”
64.3.2.2 “Foregut Hypothesis”
64.3.2.3 “Hindgut Hypothesis”
64.3.2.4 Fat Malabsorption Theory
64.3.2.5 Effect on Ghrelin
64.3.3 Hypertension
64.3.4 Dyslipidemia
64.4 Conclusion
References
Chapter 65: Duodenal Switch (DS) for the Surgical Treatment of Diabetes and Metabolic Disease
65.1 Introduction
65.2 Comparative Literature
65.3 Randomized Controlled Trials for Diabetes
65.4 Recidivism of Diabetes Following RYGB
65.5 Comparative Physiology
65.6 Effect of Physiology on Metabolic Syndrome
65.7 What Are the Potential Pathways to Explain?
65.8 SADI-S and Its Impact on DM
65.9 Clinical Application to the Practicing Surgeon
References
Chapter 66: Postoperative Care
66.1 General Considerations
66.2 Postoperative Admission to ICU
66.3 Routine Examinations After Surgery
66.4 Patients’ Comorbidities Management After Surgery
66.4.1 Type 2 Diabetes
66.4.2 Hypertension
66.4.3 Dyslipidemia
66.4.4 Obstructive Sleep Apnea
66.4.5 Other Pharmacological Treatments
66.4.6 Other Considerations
66.4.7 Patient Discharge
References
Chapter 67: Metabolic Syndrome and the Influence of Bile Acids
67.1 Bile Acids
67.2 Bile Salt Physiology
67.3 Increased Bile Acid Levels and the Improvement of Metabolic Syndrome After Bariatric Surgery
67.4 FXR and TGR5 Bile Acid Nuclear Receptors as Molecular Targets of Surgery Bariatric
67.5 Bile Acid and Duodenal Switch and Its Derivatives
67.6 Conclusions
References
Index