دانلود کتاب Duodenal Switch and Its Derivatives in Bariatric and Metabolic Surgery: A Comprehensive Clinical Guide

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Foreword Preface Acknowledgments Contents Part I: Introduction Chapter 1: A Brief History of the Duodenal Switch 1.1 History 1.2 The Initiator: Scopinaro 1.3 The Pioneers: Hess and Marceau 1.4 The Laparoscopic DS (Gagner) and the Idea of Staging 1.5 Clinical Outcomes 1.6 New Developments: The Loop-DS References Chapter 2: Duodenal Switch: Mechanisms of Functioning 2.1 Introduction 2.2 The Sleeve Gastrectomy 2.3 Pyloric Preservation 2.4 Biliopancreatic Diversion 2.5 Conclusion References Chapter 3: Duodenal Switch and Its Derivatives 3.1 Introduction 3.2 History 3.3 Derivative Procedures of Duodenal Switch 3.4 Pre-operative Consideration 3.4.1 Indications for Surgery 3.4.2 Contraindications 3.5 Procedural Details 3.5.1 Patient Positioning and Port Placement 3.5.2 Laparoscopic Portion 3.5.3 Cholecystectomy 3.5.4 Sleeve Gastrectomy 3.5.5 Duodenal Dissection and Duodeno-Ileostomy 3.5.6 Ileo-Ileal Anastomosis 3.5.7 Mesentery Defect Closures 3.6 Post-operative Care 3.7 Complications 3.8 Outcomes 3.9 BPD-DS as Revisional Surgery for Weight Regain 3.10 Summary References Chapter 4: Primary Single Anastomosis Duodenal Switch: Perspective from a Lengthy Experience 4.1 Historical Perspective of Weight Loss Procedures 4.2 The Next Frontier 4.3 To Treat Obesity, It Is Necessary to Understand the Cause 4.4 The Next Domain: Glucose Variability and Matching Bariatric Surgery to Modern Obesity Treatment 4.5 Rationalization for Patient Selection 4.6 SADI/SADS vs. Traditional Roux DS 4.7 SADS vs. RYGB 4.8 SADS vs. OAGB (One Anastomosis Gastric Bypass) 4.9 Surgical Technique 4.10 Issues in Complication Management 4.11 Malnutrition: Input and Output Issues 4.12 Electrolyte and Micronutrient Deficiencies 4.13 Fat Soluble Vitamins 4.14 Vitamin B12 4.15 Trace Elements 4.16 Metabolic Bone Disease 4.17 Nephrolithiasis 4.18 SADS Surgical Correction for Malabsorption 4.19 Additional Complications of SADS: Gastroesophageal Reflux Disease (GERD) 4.20 Conclusion References Chapter 5: Duodenal Switch and Its Derivatives in Bariatric and Metabolic Surgery 5.1 Introduction 5.2 Preoperative Workup 5.3 Techniques and Derivatives of BPD/DS 5.4 Post-operative Care 5.5 Complications 5.6 Outcomes 5.7 Conclusion References Part II: Weight Loss Surgery Chapter 6: Pathophysiology of the Cardiometabolic Alterations in Obesity 6.1 Introduction 6.2 Body Fat Distribution and Excess Accumulation of Visceral Adipose Tissue 6.3 Pathophysiology of the Cardiometabolic Alterations in Obesity: Adipose Tissue Dysfunction 6.4 Cardiometabolic Alterations Associated with Visceral Obesity 6.5 Reversal of Metabolic Dysfunction After Bariatric Surgery 6.6 Conclusions References Chapter 7: Pathophysiology of Bile Acid Regulation 7.1 Introduction 7.2 Physiology of Bile Acid 7.3 Pathophysiology of Bile Acid Regulation 7.3.1 Receptors and Signaling 7.3.2 Obesity, Bariatric Surgery, and Diabetes 7.3.3 Non-alcoholic Fatty Liver Disease and Non-alcoholic Steatohepatitis 7.4 Conclusion References Chapter 8: Nonalcoholic Steatohepatitis (NASH) 8.1 Introduction 8.2 Epidemiology 8.3 Pathogenesis 8.4 Clinical Manifestations 8.4.1 Diagnosis 8.5 Treatment 8.6 Medication References Chapter 9: Patient Selection 9.1 Potential Candidates for Duodenal Switch 9.2 Selection Algorithms 9.3 Contraindications for Duodenal Switch 9.4 Duodenal Switch as a Staged Procedure 9.5 Duodenal Switch as a Rescue for Failed Primary Procedure References Chapter 10: Psychological and Psychiatric Workup 10.1 Introduction 10.2 Important Psychological Aspects on the Evaluation and Follow-Up of Candidates for Bariatric Surgery 10.3 Important Psychiatric Aspects on the Evaluation and Follow-Up of Candidates for Bariatric Surgery 10.4 Impulsivity and Compulsivity 10.5 Binge Eating Disorder 10.6 Night Eating Syndrome 10.7 Emotional Eating 10.8 Food Addiction 10.9 Grazing 10.10 Addiction Transfer After Bariatric Surgery 10.11 Final Considerations References Chapter 11: Nutritional, Behavioral, and Support for Duodenal Switch 11.1 Introduction 11.2 Nutritional Pre-optimization and ERABS 11.2.1 Pre-optimization (Pre-habilitation) 11.2.2 Optimizing Nutrition Status 11.2.3 Pre-operative Weight Loss and Nutrition Counseling 11.2.4 Liver-Shrinking Diet and ERABS 11.2.5 Pre-operative Information and Counseling 11.3 Potential Nutrition Complications 11.4 Encouraging Dietary Behavioral Changes 11.5 Conclusion References Chapter 12: Preoperative Endoscopy 12.1 Introduction 12.2 Role of Esophagogastroduodenoscopy Prior to Bariatric and Metabolic Surgery Procedures 12.2.1 Abnormal Findings 12.2.2 Testing and Treatment of H. pylori References Chapter 13: Postoperative Care 13.1 Introduction 13.2 Multidisciplinary Team 13.3 Postoperative Unit 13.4 Analgesia 13.5 Diet 13.6 Thromboprophylaxis 13.7 Investigations 13.8 Adjustments of Comorbidity Treatments 13.9 Antihypertensive Medication 13.10 Dyslipidemia Medication 13.11 Diabetic Medication 13.12 Contraceptive Counselling 13.13 Vitamins 13.14 Length of Stay References Chapter 14: Preoperative Testing and Counseling 14.1 Introduction 14.2 History 14.3 Laboratory Testing 14.4 Psychosocial Evaluation 14.5 GI Evaluation 14.6 VTE/Deep Venou Thrombosis (DVT) 14.7 Cholelithiasis/Abdominal US 14.8 Medical Subspecialty Evaluation 14.8.1 Pulmonary 14.8.2 Cardiology 14.8.3 Endocrinology 14.9 Informed Consent 14.10 Conclusion References Chapter 15: Risk Assessment and Reduction 15.1 Risk Assessment 15.2 Risk Reduction 15.2.1 Smoking 15.2.2 Substance Abuse 15.2.3 Psychosocial Evaluation 15.2.4 Cardiopulmonary Assessment 15.2.5 Chronic Steroid Immunosuppression 15.2.6 Preoperative Weight Loss and Liver Volume Reduction 15.2.7 Hospital and Programmatic Support of Bariatric Surgery References Chapter 16: Airway Evaluation and Management 16.1 Obstructive Sleep Apnea History and Management 16.2 Possible Difficult Laryngoscopy 16.3 Possible Difficult Mask References Chapter 17: Patient Positioning and Positioning for Bariatric Surgery 17.1 General Considerations for Patient Positioning 17.2 Considerations for Selected Positions and Changes in Physiology 17.2.1 Supine 17.2.2 Semi-fowler/fowler’s 17.2.3 Lithotomy 17.2.4 Lateral Decubitus 17.2.5 Robotic Surgery 17.3 Summary References Chapter 18: Intraoperative Monitoring of the Morbidly Obese Patient 18.1 Pulse Oximetry 18.2 Electrocardiogram 18.3 Blood Pressure 18.4 Arterial Line 18.5 End Tidal Carbon Dioxide Monitoring 18.6 Temperature 18.7 Additional Monitors 18.7.1 Noninvasive Cardiac Output Monitors 18.7.2 Processed Electroencephalogram References Chapter 19: Method of Anesthesia: Gas Selection and Adjunct Medications 19.1 Definition of Morbid Obesity 19.2 Why It Is Important to Dose Inhalational Agents and Other Drugs Differently in Obese Patients 19.3 Anesthesia Gases Used for Bariatric Surgery 19.4 Drug Dosing for Obese Patients 19.5 Emergence from Inhalational Anesthesia 19.5.1 Adjunct Medications References Further Reading Chapter 20: Regional Anesthesia in Bariatric Surgery 20.1 Introduction 20.2 Regional Block 20.3 Transversus Abdominal Plane Block (TAP Block) 20.3.1 Outcomes 20.3.2 Erector Spinae Plane Block (ESPB) 20.4 Conclusion References Chapter 21: Multimodal Analgesia in Bariatric Surgery 21.1 Introduction 21.2 Opiates 21.3 Acetaminophen 21.4 Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) 21.5 N-Methyl-D-Aspartate Antagonists 21.6 Alpha-2 Agonists 21.7 Calcium Channel Blocker 21.8 Lidocaine Patches 21.9 Tramadol 21.10 Local Anesthetic Wound Infiltration and Infusions 21.11 Conclusion References Chapter 22: Anatomical Considerations 22.1 Introduction 22.2 Sleeve Gastrectomy 22.3 Duodenal Approach 22.4 Jejunum and Ileum 22.5 Summary References Chapter 23: Robotic Duodenal Switch and SADI-S: Technical Aspects 23.1 Introduction 23.2 Biliopancreatic Diversion with Duodenal Switch 23.2.1 Patient Positioning and Port Placement 23.2.2 Duodenal Dissection 23.2.3 Sleeve Gastrectomy 23.2.4 Duodeno-Ileostomy 23.2.5 Ileoileostomy 23.2.6 Hernia Defects 23.2.7 Anastomotic/Staple Line Leak Test 23.3 Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy 23.4 Conclusion References Chapter 24: Laparoscopic Biliopancreatic Diversion with Duodenal Switch: Surgical Technique 24.1 Introduction 24.2 Surgical Technique (Video 24.1) 24.2.1 Preoperative Evaluation 24.2.2 Preparation and Patient Positioning 24.2.3 Peritoneal Access and Ports Positioning 24.2.4 Gastric Mobilization 24.2.5 Duodenal Dissection 24.2.6 Sleeve Gastrectomy 24.3 Small Bowel Measurement and Transection 24.3.1 Duodenoileostomy 24.3.2 Ileoileostomy 24.4 Closure of Mesenteric Window and Petersen Window 24.5 Postoperative Care 24.6 Conclusion References Chapter 25: SADIS: Technical Details 25.1 Introduction 25.2 Surgical Technique 25.2.1 Patient Preparation 25.2.2 Position of the Patient and the Surgical Team 25.2.3 Trocar Position 25.2.4 Procedure 25.2.4.1 Sleeve Gastrectomy and Duodenal Dissection 25.2.4.2 Duodeno-Ileal Bypass 25.3 Postoperative Course 25.4 Technical Pitfalls 25.5 Technical Advantages of SADI-S 25.6 Conclusions References Chapter 26: Technical Aspects of Single Anastomosis Duodenal Switch: SIPS Version References Chapter 27: Duodenal Bipartition or Side-to-Side Duodeno-Ileostomy: Rationale and Technical Details 27.1 Rationale 27.2 Technique References Chapter 28: Duodeno-Ileal Anastomosis with Hand-Sewn Technique 28.1 Introduction 28.2 Surgical Technique 28.3 Potential Points of Discussion References Chapter 29: Circular Anastomosis in Duodenal Switch 29.1 Introduction 29.2 Circular Mechanic Duodeno-Ileal Anastomosis 29.3 Technical Issues 29.4 Technical Variations of the Circular Anastomosis 29.5 Points of Discussion 29.6 Summary References Chapter 30: Duodenoileal Anastomosis with Linear Stapler Technique 30.1 Introduction 30.2 Procedural Approach 30.2.1 Common Limb Measurement 30.2.2 Duodenal Dissection 30.2.3 Duodenoileal Anastomosis References Chapter 31: Staged Duodenal Switch for High-Risk Patients 31.1 Introduction 31.2 Procedure 31.3 Stage 1: Sleeve Gastrectomy 31.4 Stage 2: Duodenoileostomy and Ileoileostomy 31.4.1 Duodenal Transection 31.4.2 Alimentary Limb Creation 31.4.3 Duodenoileostomy 31.4.4 Ileoileostomy 31.4.5 Robotic-Assisted Laparoscopic BPD/DS 31.5 High-Risk Classification Leading to Staging 31.6 Postoperative Care 31.7 Indications 31.8 Contraindications 31.9 Complications 31.9.1 Surgical 31.9.2 Nutritional 31.10 Outcomes 31.11 Conclusions References Chapter 32: Duodenal Switch, SADI, and SIPS in Adolescent References Chapter 33: Duodenal Switch (DS), Single Anastomosis Duodeno-Ileal Bypass (SADI) and Stomach Intestinal Pylorus-Sparing Surgery (SIPS) in the Elderly 33.1 Introduction 33.2 Obesity and Age 33.3 Bariatric Surgery in the Elderly 33.4 Choice of Bariatric Procedure in the Elderly 33.5 Preoperative Assessment, Anaesthesia and Perioperative Care in Elderly Patients 33.6 Surgical Technique 33.7 Postoperative Management: Enhanced Recovery 33.8 Long-Term Results References Chapter 34: Right Gastric Artery Ligation: The Brazilian Results References Chapter 35: Surgery Failure: What Are the Options? 35.1 Introduction 35.2 Prevalence of Failure 35.3 Reasons for Failure 35.3.1 Patient Comorbidities 35.3.2 Psychological Conditions 35.3.3 Physiologic/Anatomic Reasons 35.3.4 Lack of Support 35.3.5 Noncompliance with Lifestyle Changes 35.4 Patient Assessment 35.5 Options Following Failure 35.5.1 Medical Options 35.5.2 Surgical Options 35.6 Conclusions References Chapter 36: Causes of Weight Regain After Duodenal Switch and Its Derivatives 36.1 Introduction 36.2 Long-Term Outcomes of Duodenal Switch and Derivatives 36.2.1 Classic DS 36.2.2 Single Anastomosis DS Derivatives 36.3 Weight Regain After Duodenal Switch and Derivatives 36.3.1 Classic DS 36.3.2 Single Anastomosis DS Derivatives 36.4 Causes of Weight Regain 36.4.1 Lifestyle and Patient-Related Factors 36.4.2 Surgery-Related Factors 36.5 Summary References Chapter 37: Revisional Surgery for Weight Regain 37.1 Introduction 37.2 Incidence and Causes of Weight Regain 37.3 Definition of Weight Regain 37.4 Preoperative Evaluation 37.5 Selecting the Type of Revisional Surgery 37.5.1 Adjustable Gastric Band 37.5.2 Non-adjustable Band/Vertical Banded Gastroplasty 37.5.3 Roux-En-Y Gastric Bypass 37.5.4 Sleeve Gastrectomy 37.5.5 Biliopancreatic Diversion With or Without Duodenal Switch 37.6 Role and Impact of Duodenal Switch 37.7 Weight Loss Following Revisional Surgery 37.8 Complications of Revisional Surgery 37.9 Conclusion References Chapter 38: Conversion of Sleeve Gastrectomy to Duodenal Switch and SADI-S 38.1 Introduction 38.2 Weight Loss Failure After SG 38.3 Reoperative Procedures for Failure in Weight Control After Sleeve 38.4 Conversion of SG to BPD-DS and SADI-S: Surgical Technique 38.5 Results of Conversion from SG into BPD-DS or SADI-S/OADS 38.6 Summary References Chapter 39: Gastric Band Revision to Duodenal Switch 39.1 Introduction 39.2 Materials and Methods 39.3 Preoperative Preparation 39.4 Surgical Technique 39.5 Results References Chapter 40: Endoscopic Treatment of Weight Regain in Duodenal Switch 40.1 Introduction 40.2 Conclusion References Chapter 41: Conversion of Gastric Bypass to Duodenal Switch 41.1 Introduction 41.2 Gastric Bypass Failure 41.3 Surgical Options 41.4 Surgical Treatment 41.4.1 Part 1: Gastrogastrostomy Creation 41.4.2 Part 2: Sleeve Gastrectomy 41.4.3 Part 3: Reversal of Jejunojejunostomy 41.4.4 Part 4: Duodenoileostomy Creation 41.4.5 Part 5: Ileoileostomy Creation 41.4.6 Part 6: Surgery Completion 41.5 Postoperative Care 41.6 One Stage Vs. Two Stage 41.7 Traditional Vs. Single Anastomosis 41.8 Results 41.9 Conclusions References Chapter 42: Management of Duodenal Stump Blowout 42.1 Introduction 42.2 Presentation of Stump Blowout 42.3 Diagnosis of a Blowout 42.4 General Management of a Stump Blowout 42.5 Conservative Management 42.6 Percutaneous Approach 42.7 Surgical Management 42.8 Special Considerations in Duodenal Switch 42.9 Conclusion References Chapter 43: Duodenoileal Anastomosis Testing 43.1 Introduction 43.2 Methylene Blue Test (Fig. 43.3) 43.3 Water-Air Leak Test (Fig. 43.1a and b) 43.4 Intraoperative Endoscopic Direct Visualization 43.5 Indocyanine Green Test and Combination of Blend and Endovascular Test (Fig. 43.2a and b) References Chapter 44: Closing the Mesenteric Defects 44.1 Introduction 44.2 Experience from the Roux-en-Y Gastric Bypass 44.3 Experience in Duodenal Switch/Derivatives 44.4 Closure Techniques 44.5 Ileo-ileostomy Defect (See Video 44.1) 44.6 Petersen Defect (See Video 44.2) 44.7 Tips and Tricks 44.8 Summary References Chapter 45: Preventing Surgical Complications 45.1 Preoperative Prevention 45.2 Intraoperative Techniques 45.3 Postoperative Care 45.4 Conclusion References Chapter 46: Malabsorptive Complications 46.1 Introduction 46.2 Long-Term and Nutritional Complications 46.2.1 Anatomic Effects on Nutrition 46.2.2 Hypoproteinemia 46.2.3 Chronic Diarrhea 46.2.4 Electrolyte Repletion and Refeeding Syndrome 46.2.5 Micronutrient Considerations 46.2.5.1 Vitamin A 46.2.5.2 Calcium and Vitamin D 46.2.5.3 Folic Acid 46.2.5.4 Zinc 46.2.5.5 Iron 46.2.6 Metabolic Bone Disease 46.2.7 Nephrolithiasis 46.3 Conclusion References Chapter 47: Postoperative Psychological Assistance 47.1 Introduction 47.2 Cognitive Behavioral Therapy (CBT) 47.3 Interpersonal Psychotherapy (IPT) for Obesity 47.4 Mindfulness 47.5 ER-Based Methods 47.6 Final Considerations References Chapter 48: Surgical Management of Leaks 48.1 Introduction 48.2 Early Surgical Management 48.3 Leak from the Sleeve 48.4 Leak from the Duodenoileostomy 48.5 Leak from the Duodenal Stump 48.6 Leak from the Jejunoileostomy References Chapter 49: Internal Hernias and Bowell Obstruction 49.1 Introduction 49.2 Discussion 49.3 Conclusion References Chapter 50: Management of Portal Vein Thrombosis Following Bariatric Surgery 50.1 Introduction 50.2 Presentation 50.3 Diagnosis: Imaging and Laboratory Testing 50.4 Prophylactic Anticoagulation Following Bariatric Surgery 50.5 Treatment of Venous Thromboembolism in Obese Patients and After Bariatric Surgery 50.6 Management of Portal Vein Thrombosis After Bariatric Surgery 50.7 Conclusion References Chapter 51: Gallstones and Choledocholithiasis 51.1 Introduction 51.1.1 Cholelithiasis 51.1.2 Choledocolithiasis 51.2 ERCP in Patients with Surgically Altered Anatomy 51.3 Transgastric and Transenteric ERCP Assisted by Laparoscopy 51.4 Final Considerations References Chapter 52: Hyperinsulinemic Postprandial Hypoglycemia After Duodenal Switch 52.1 Introduction 52.2 Etiology 52.3 Diagnosis 52.4 Treatment 52.5 Case Report and Reversal of Duodenal Switch into Normal Anatomy with Sleeve Gastrectomy (Fig. 52.1; See Video 52.1) 52.6 Conclusions References Chapter 53: Diarrhea After Duodenal Switch: Medical and Surgical Management 53.1 Diarrhea 53.2 Pathophysiology of Duodenal Switch and Diarrhea 53.2.1 Evaluation of Diarrhea 53.2.1.1 History 53.2.2 Physical Exam 53.2.3 Testing 53.3 General Management of Diarrhea 53.3.1 Medical Management of Diarrhea Related to Nutrient Malabsorption 53.3.2 Patient Education 53.3.2.1 Surgical Treatment of Diarrhea References Chapter 54: Endoscopic Treatment of Complications 54.1 Introduction 54.2 Major Approaches on the Duodenal Switch 54.2.1 General Information: Duodenal Switch 54.2.2 Major Complications 54.2.2.1 Leak 54.2.2.2 Endoscopic Treatment 54.2.2.3 Blocking Methods: Self-Expanding Metal Prosthesis 54.2.3 Internal Drainage Methods 54.2.3.1 Septotomy with Dilation 54.2.3.2 Internal Drainage with Pigtail Drain 54.2.3.3 Vacuum Endoscopic Therapy 54.2.3.4 Hemorrhage 54.3 Final Considerations References Chapter 55: Global Analysis of Our Experience with Hypoabsorptive Technique: >500 Cases DS vs. SADI-S 55.1 Introduction 55.1.1 How We Do It 55.1.2 Our Register 55.1.3 Statistical Analysis 55.1.4 Our Experience 55.2 Discussion 55.3 Conclusions References Chapter 56: Body Contouring After Duodenal Switch 56.1 Introduction 56.2 Preoperative Evaluation and Planning 56.2.1 Weight History 56.2.2 Body Mass Index (BMI) 56.2.3 Nutritional Assessment 56.2.4 Medical, Surgical, and Social History 56.2.5 Insurance Coverage 56.2.6 Venous Thromboembolism (VTE) 56.3 Surgical Procedures 56.3.1 Staging 56.3.2 Upper Body 56.3.2.1 Arm 56.3.2.2 Back 56.3.2.3 Chest (Male) 56.3.2.4 Breast (Female) 56.3.3 Lower Body 56.3.3.1 Abdomen/Buttocks 56.3.3.2 Thigh 56.4 Complications 56.5 Outcomes 56.5.1 Quality of Life 56.6 Conclusion References Chapter 57: Bariatric Surgery Population in the ICU 57.1 Obesity Definitions 57.2 ICU Admission Criteria 57.3 The Respiratory System 57.4 The Cardiovascular System 57.5 The Renal System 57.6 Pharmacology in the ICU 57.7 Assessing Caloric Needs in the Critically Ill Obese Patient 57.8 Nutrition in the Post-bariatric Surgery Patient 57.9 Deep Venous Thrombosis Prophylaxis 57.10 The Obesity Paradox in Critical Care 57.11 Nursing Care of the Obese ICU Patient References Chapter 58: Bariatric Emergencies for the General Surgeon 58.1 Implantable Devices 58.2 Gastrointestinal Bleed 58.2.1 Leak 58.2.2 Perforation 58.2.3 Small Bowel Obstructions 58.2.4 Stenosis and Volvulus 58.3 Conclusions References Chapter 59: Robotic Bariatric Surgeon Training 59.1 Introduction 59.2 Simulation Training 59.3 Learning Curve and Training Curricula in Bariatric Robotic Surgery 59.4 Stages of Training in the da Vinci® System References Part III: Metabolic and Diabetes Type 2 Surgery Chapter 60: Mechanisms of Control of Diabetes 2 with Duodenal Switch 60.1 Introduction 60.2 Risk Factors 60.3 Bariatric Surgery and DM2 60.4 Mechanisms for DM2 Control 60.4.1 Decreased Caloric Intake 60.4.2 Weight Loss 60.4.3 Malabsorption 60.4.4 Duodenal/Jejunal Bypass 60.5 Conclusions References Chapter 61: The Evolution of Single-Anastomosis Duodenal Switch 61.1 Introduction 61.1.1 The Journey to the Duodenal Switch 61.1.2 The Initiation of the Single-Anastomosis Duodenal Switch 61.1.3 Ever-Evolving Variations 61.2 Conclusions References Chapter 62: Chapters on Metabolic Syndrome Control and the Influence of Hormonal Changes Post-duodenal Switch (DS) 62.1 The Hormonal Changes After a Duodenal Switch and Their Potential Mechanisms 62.1.1 Reductions in Food Intake 62.1.2 Mechanical Factors 62.1.3 Malabsorption 62.1.4 Hypothalamic Signalling 62.1.5 Gut Hormones and Leptin 62.1.5.1 Glucagon-Like Peptide-1 (GLP-1) 62.1.5.2 Oxyntomodulin (OXM) 62.1.5.3 Peptide YY (PYY) 62.1.5.4 Ghrelin 62.1.5.5 Leptin 62.1.6 Vagal Signalling 62.1.7 Bile Acids 62.1.8 Gut Microbiota 62.2 The Impact of DS on the Complications of Obesity 62.2.1 What are the Metabolic Issues Caused by Obesity and How Do They Change After DS? 62.2.1.1 Airway 62.2.1.2 BMI Reduction 62.2.1.3 Cardiovascular Disease Hypertension 62.2.1.4 Diabetes Mellitus 62.2.1.5 Economic 62.2.1.6 Functional 62.2.1.7 Gonadal 62.2.1.8 Health Status Perceived QoL 62.2.1.9 Image 62.2.1.10 Junction of the Gastroesophagus 62.2.1.11 Kidney 62.2.1.12 Liver: Nonalcoholic Fatty Liver Disease (NAFLD) 62.3 Glycaemic Control and Diet in Patients Undergoing Bariatric Surgery 62.4 Pre-operative Glycaemic Management of the Patient with Diabetes Undergoing Bariatric Surgery 62.5 Psychologic Support Pre-operatively 62.6 Dietician Support Pre-operatively References Chapter 63: Staged Duodenal Switch for High-Risk Patients 63.1 Introduction 63.2 Procedure 63.2.1 Stage 1: Sleeve Gastrectomy 63.2.2 Stage 2: Duodenoileostomy and Ileoileostomy 63.2.2.1 Duodenal Transection 63.2.2.2 Alimentary Limb Creation 63.2.2.3 Duodenoileostomy 63.2.2.4 Ileoileostomy 63.2.2.5 Robotic-Assisted Laparoscopic BPD/DS 63.3 High-Risk Classification Leading to Staging 63.3.1 Postoperative Care 63.3.2 Indications 63.3.3 Contraindications 63.3.4 Complications 63.3.4.1 Surgical 63.3.4.2 Nutritional 63.3.5 Outcomes 63.4 Conclusions References Chapter 64: Duodenal Switch in Patients with Metabolic Syndrome 64.1 Introduction 64.2 Hormones Impacted by Bariatric Surgery 64.2.1 Leptin 64.2.2 Ghrelin 64.2.3 Incretins 64.2.4 Polypeptide YY 64.3 Metabolic Syndrome and the Duodenal Switch 64.3.1 Weight Loss 64.3.2 Diabetes and Pre-diabetes 64.3.2.1 “Gastric Hypothesis” 64.3.2.2 “Foregut Hypothesis” 64.3.2.3 “Hindgut Hypothesis” 64.3.2.4 Fat Malabsorption Theory 64.3.2.5 Effect on Ghrelin 64.3.3 Hypertension 64.3.4 Dyslipidemia 64.4 Conclusion References Chapter 65: Duodenal Switch (DS) for the Surgical Treatment of Diabetes and Metabolic Disease 65.1 Introduction 65.2 Comparative Literature 65.3 Randomized Controlled Trials for Diabetes 65.4 Recidivism of Diabetes Following RYGB 65.5 Comparative Physiology 65.6 Effect of Physiology on Metabolic Syndrome 65.7 What Are the Potential Pathways to Explain? 65.8 SADI-S and Its Impact on DM 65.9 Clinical Application to the Practicing Surgeon References Chapter 66: Postoperative Care 66.1 General Considerations 66.2 Postoperative Admission to ICU 66.3 Routine Examinations After Surgery 66.4 Patients’ Comorbidities Management After Surgery 66.4.1 Type 2 Diabetes 66.4.2 Hypertension 66.4.3 Dyslipidemia 66.4.4 Obstructive Sleep Apnea 66.4.5 Other Pharmacological Treatments 66.4.6 Other Considerations 66.4.7 Patient Discharge References Chapter 67: Metabolic Syndrome and the Influence of Bile Acids 67.1 Bile Acids 67.2 Bile Salt Physiology 67.3 Increased Bile Acid Levels and the Improvement of Metabolic Syndrome After Bariatric Surgery 67.4 FXR and TGR5 Bile Acid Nuclear Receptors as Molecular Targets of Surgery Bariatric 67.5 Bile Acid and Duodenal Switch and Its Derivatives 67.6 Conclusions References Index