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    Duodenal switch in revisional bariatric surgery: conclusions from an expert consensus panel

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    Duodenal_Switch_2019.pdf
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    Author
    Merz, Alexa E
    Blackstone, Robin B
    Gagner, Michel
    Torres, Antonio J
    Himpens, Jacques
    Higa, Kelvin D
    Rosenthal, Raul J
    Lloyd, Aaron
    DeMaria, Eric J
    Affiliation
    Univ Arizona, Banner Univ, Dept Gen Surg
    Univ Arizona, Banner Univ, Inst Obes & Metab Disorders
    Issue Date
    2019-06-01
    Keywords
    Duodenal switch
    Expert consensus
    Obesity
    Revisional bariatric surgery
    
    Metadata
    Show full item record
    Publisher
    ELSEVIER SCIENCE INC
    Citation
    Merz, A. E., Blackstone, R. B., Gagner, M., Torres, A. J., Himpens, J., Higa, K. D., ... & DeMaria, E. J. (2019). Duodenal switch in revisional bariatric surgery: conclusions from an expert consensus panel. Surgery for Obesity and Related Diseases.
    Journal
    SURGERY FOR OBESITY AND RELATED DISEASES
    Rights
    Copyright © 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
    Collection Information
    This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.
    Abstract
    Background: Duodenal switch (BPD/DS) is gaining popularity as a secondary procedure for inadequate weight loss after an initial operation. Objectives: We aimed to generate expert consensus points on the appropriate use of BPD/DS in the revisional bariatric surgical setting. Setting: Data were gathered at an international conference with attendees from a variety of different institutions and settings. Methods: Sixteen lines of questioning regarding revisional BPD/DS were presented to an expert panel of 29 bariatric surgeons. Current available literature was reviewed extensively for each topic and proposed to the panel before polling. Responses were collected and topics defined as achieving consensus (>= 70% agreement) or no consensus (<70% agreement). Results: Consensus was present in 10 of 16 lines of questioning, with several key points most prominent. Conclusions: As a second-stage procedure, BPD/DS is most appropriate after sleeve gastrectomy (SG) for the treatment of super morbid obesity (96.7% agree) or as a subsequent operation for a reliable patient with insufficient weight loss after SG (88.5%). In a patient with weight regain and reflux and/or enlarged fundus after SG, Roux-en-Y gastric bypass is preferable and BPD/DS should be avoided (90%). BPD/DS should not be used prophylactically in patients with a history of jejunoileal bypass who are otherwise doing well (80.8%). Applicability of BPD/DS is limited by technical difficulty; 86.2% of experts would routinely recommend or consider the procedure if it were more technically feasible after failed bypass. No consensus was found on approaches to revision of BPD/DS for protein malnutrition. (C) 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
    Note
    12 month embargo; published online: 1 June 2019
    ISSN
    1550-7289
    PubMed ID
    31076367
    DOI
    10.1016/j.soard.2019.03.009
    Version
    Final accepted manuscript
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.soard.2019.03.009
    Scopus Count
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    UA Faculty Publications

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