The main goal of bariatric surgery is to select the right procedure for each patient. With the increasing popularity of sleeve gastrectomy, biliopancreatic diversion with duodenal switch (BPD-DS) is an standard procedure in the bariatric surgery arsenal for patients with weight regain.
The patient is placed under general anesthesia, in a split-legs position. A 10-mm optic trocar is placed two hand spans below the xyphoid process. Two 12-mm ports are placed at the same level on the right and left flanks. Three 5-mm ports are placed: one on the left upper quadrant, one on the left flank for the assistant, and a final one in the epigastrium for liver retraction.
The procedure starts with the duodenal dissection. The pylorus is identified with a clip and the peritoneum of the duodenum is opened in its inferior and superior borders. A window is created and a Penrose drain is used for retraction. An endostapler is used for transection.
The patient is placed in the head-down position with the left side down. The surgeon moves to the left side of the patient. The ileocecal valve is identified and a 100 cm strip is used to measure the small bowel. 100 cm from the ileocecal valve the small bowel is marked with a clip and a suture and a further 150 cm are measured; at this level (250 cm from the ileocecal valve) the small bowel is transected using an endostapler. A Barcelona-type side-to-side ileo-ileal anastomosis is performed using an endostapler.
The patient is placed in a head-up position and the surgeon moves between the patient’s legs. The alimentary limb is placed on the right upper quadrant and an end-to-side anastomosis is performed using the OrVil and a circular stapler. A drain guides the duodeno-ileal anastomosis.