BILIOPANCREATIC DIVERSION WITH DUODENAL SWITCH

In 1990 Scopinaro's technique of biliopancreatic diversion with distal gastrectomy (DG) and gastroileostomy was modified, A sleeve gastrecto my with duodenal switch (DS) was used instead of the distal gastrectom y; and the length of the common channel was made 100 cm instead of 50 cm. A questionnaire and a prescription for blood work were sent to 252 patients who underwent DG a mean 8.3 years ago (range 6-13 years) and 465 patients who underwent DS 4.1 years ago (range 1.7-6.0 years). Th e questionnaire response rate was 93%, and laboratory work was complet ed for 65% of both groups. The mean weight loss after DG was 37 +/- 21 kg and after DS 46 +/- 20 kg. There were fewer side effects after DS: The number of daily stools was lower (p < 0.0002), as was the prevale nce of diarrhea (p < 0.01), vomiting (p < 0.001), and bone pain (p < 0 .001). Greater benefits related to several aspects of life were report ed after DS than DG (p < 0.0001), The mean serum levels of ferritin, c alcium, and vitamin A were higher (p < 0.001), and parathyroid hormone was lower. The yearly revision rate for excessive malabsorption was 1 .7% per year after DG and 0.1% per year after DS. The two procedures w ere equally efficient for treating co-morbid conditions such as diabet es, hypertension, and hypercholesterolemia. Biliopancreatic diversion with sleeve gastrectomy/duodenal switch and a 100-cm common limb was s hown to produce greater weight loss with fewer side effects.