'Hybrid' Bariatric Surgery: Bilio-pancreatic Diversion and Duodenal Switch- Preliminary Experience

BACKGROUND: Hybrid, combined or mixed bariatric surgery is the combination of a degree of 'malabsorption' (as achieved by the intestinal bypass) with a 'restriction' (as achieved by gastric bypass or gastroplasty), thereby simultaneously reducing the absorption of fats in the small bowel and decreasing the intake of food. METHODS: A modification of the bilio-pancreatic diversion (BPD) with a duodenal switch procedure, vertical lineal gastrectomy and preservation of the pylorus, has been used in 23 patients. The antropyloric pump and 4 cm of the duodenum are left intact to preserve physiologic gastric emptying and to prevent anastomotic ulcer. The use of staplers and continuous running sutures reduces surgical risks and operative time. RESULTS: One patient, converted from a vertical gastroplasty, had an intrathoracic esophageal perforation and died of multi-systemic organ failure, a mortality rate of 4.5%. One patient had a partial dehiscence of the laparotomy wound. Three patients developed subcutaneous seromas. Mean weight losses during the first 4 months were 13, 11, 6 and 5 kg, with a loss of 70% of excess weight in patients approaching 1 year. No patient needs treatment for diarrhea. No serious secondary side-effects have been detected. CONCLUSION: This operation appears to result in very satisfactory weight loss, improved quality of life, and a low incidence of complications.