Duodenal Switch
The Duodenal Switch procedure was first introduced by Dr. Tom DeMeester as a surgical treatment for bile reflux gastritis. Originally it was not intended to be a bariatric or metabolic or weight loss procedure. The main goal of the procedure was to change ("switch") the path of duodenal digestive juice flow as it relates to food flow from the stomach. Normally the stomach empties into the duodenum and mixes there with digestive juices eminating from the Ampula of Vater, the orifice that excretes the biliary flow of the liver and gallbladder along with pancreatic excretions, more belevolently known as exocrine digestive juices. By transecting the duodenum above the Ampula of Vater, but below the pylorus, the duodenal functions above the ampula and the pyloric function remains preserved within the "food-flow tract" or "Alimentary Tract" while the duodenum below the transection becomes the origin of the bilio-pancreatic limb.
Biliopancreatic Diversion with Duodenal Switch
Scopinaro Procedure
The Scopinaro Procedure was developed by Nicola Scopinaro in Italy in the 1980s. The concept involved resecting the lower stomach and leaving an orange size proximal stomach without a narrowed (or restrictive) gastro-jejunostomy ansatomosis. The reconstruction is a roux-en-Y however there is one distinct difference: the biliary limb is much longer than theroux limb or the common channel.
Dr. Hess
Dr. Hess combined the BPD concept devised by Dr. Scopinaro and the Duodenal Switch devised by Dr. DeMeester by resecting the lateral greater curvature of the stomach instead of the lower stomach and thereby preserving the pylorus and duodenum but still being able to replicate the lengthy biliopancreatic limb. Although the lateral gastrectomy idea was novel to this new procedure, it was performed for 20 years always as a component of the duodenal switch and never considered a stand-alone procedure until introduced in 2000 by Dr. Elariny as a novel independent procedure for metabolic and bariatric surgery.
Dr. Marceau
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