Morbid obesity has become a worldwide pandemic and has been treated by different means according to surgeon and/or patient preferences. It encompasses 1.7 billion people and bariatric surgery is the only effective treatment of morbid obesity.1,2 The formal indications for surgical treatment are still based on body mass index above 40 kg/m2 or above 35 kg/m2 associated with comorbidities.3 The surgical techniques applied for bariatric surgeries are essentially restrictive, malabsorptive, or combined.4
Among restrictive procedures, the most commonly described are the vertical banded gastroplasty, the laparoscopic silicone adjustable gastric band, and the sleeve gastric resection.4,5 Gastric pacemaker that produces early satiety may be considered restrictive as well.6,7 Intragastric balloon, which is restrictive, is not a formal surgical intervention.8
Malabsorptive procedures that have been used for many years, mainly in the United States, have now been abandoned due to their side effects. Jejunoileal bypass and all its variants are still used by some surgeons, but are not recommended because there are better methods available with lower incidence of long-term complications.3,9
The combined procedures may be more restrictive or more malabsorptive.4 Gastric bypass with or without banding is more restrictive.2,4 The malabsorptive part of these operations is minimal and needs to be better investigated. Among the combined malabsorptive interventions are the biliopancreatic diversion with distal gastrectomy (BPD), biliopancreatic diversion with duodenal switch (BPD–DS), and the distal roux-en-Y gastric bypass (RYGBP). Other techniques are variations of these three.10–17
The most popular BPDs are those proposed by Scopinaro,17,18 including distal gastrectomy with gastroileal anastomosis and its variant, the duodenal switch, which is a vertical gastrectomy with pyloric preservation and duodenoileal anastomosis.12,13,14,19 The gastric sleeve resection is a restrictive component and the jejunoileal bypass is the malabsorptive one. The method proposed by Hess,12,13 which has been initially well studied and published by Marceau and coworkers,14,20 carries the name duodenal switch (DS) different from the procedure of duodenal diversion proposed by DeMeester et al.21 for the surgical treatment of duodenogastric reflux and alkaline gastritis. Variations also occurred with the DS, e.g., Gagner proposed a method wherein a laparoscopic adjustable gastric banding (LAGB) was added to the BPD–DS, avoiding the vertical gastrectomy.22
There is no consensus as to what constitutes success or failure after a weight loss procedure, and the long-term results remain a subject of controversies.20 The ideal weight loss surgery should allow significant durable weight loss, relief of obesity-related associated diseases, and should have low surgical morbidity and mortality rates.23 It is not possible to separate the amount of weight loss, the presence or absence of comorbidities, and changes in quality of life when evaluating the success of a bariatric treatment. This subject is beyond ...