Laparoscopic biliopancreatic diversion with a duodenal switch for morbid obesity A feasibility study in pigs

Background and Purpose: Biliopancreatic diversion with a duodenal switch is an emerging open procedure that appears as effective as other bariatric op erations. Our goal was to determine the safety and feasibility of performin g this procedure using a laparoscopic approach in a porcine model. Materials and Methods: Six 50-kg pigs underwent surgery. Intake was restric ted with a sleeve gastrectomy, and malabsorption was obtained by creating a Roux-en-Y. The Roux limb served as a 150-cm alimentary channel following a nastomosis to a transected proximal duodenum, while the other limb, or bili opancreatic channel, transported digestive juices. Where the two limbs join ed, a 100-cm common channel was formed. Results: The operation was completed in a mean time of 4.5 hours. Two of th e six pigs had an intraoperative duodenoenterostomy anastomotic leak detect ed on methylene blue testing. This leakage was thought to be related to pig anatomy and is not expected to be a problem in humans. At necropsy, all an astomoses were patent, and there were no enteroenterostomy leaks or mesente ric torsions. Conclusion: On the basis of the porcine model, laparoscopic biliopancreatic diversion with a duodenal switch is anticipated to be feasible and safe in humans. Substantial weight loss combined with the benefits of laparoscopic surgery can be expected.