[Duodenal switch: a comprehensive view of a biliopancreatic diversion in metabolic surgery]

The duodenal switch is a technique of Bariatric Surgery that modifies the Scopinaro biliopancreatic diversion, described by Hess and Marceaux in 1988, supported by the original description that made De Meester for the treatment of gastroesophageal reflux recurrent disease. It is a complex technique, probably the most laborious of all bariatric procedures until now known, which can and must be done by laparoscopy and consisting of several surgical steps. It involves the performance of a vertical gastrectomy with bougies of different diameter and a bypass Roux-en-Y into the duodenum, with different lengths limbs. Duodenoileal anastomosis is the most difficult and different techniques are described. It must be accompanied by closure of the defects and in most of the cases of an appendectomy and cholecystectomy. There have been greater than the gastric bypass Roux-en-Y in operating time, hospitalization, morbidity and mortality. Reported complications are up a 24% of the cases, early or late, these are metabolic one and easily controllable, so a good index of satisfaction with low percentage of review and no more than 1.5% mortality. Achieved a decrease of 70% of excess weight in the long term, with improvement in all co-morbidities reaching around a 95% diabetes and metabolic control of the dyslipidemias. Given the good results it should be seen as a technique of choice for the treatment of the obese patient with metabolical disorder.