- Biliopancreatic diversion with duodenal switch (BPD/DS) is the most effective bariatric surgery in super-obese patients, although technically complex and time consuming. As a primary surgery, single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is similar to BPD/DS in terms of short-term outcomes, but long-term and comparative data are lacking.
- Duodenal switch and single anastomosis modifications continue to gain greater interest among bariatric surgeons. Limiting factors to adoption include concerns around the nutritional management, patient compliance and follow-up, and the technical challenge of the operation. The majority of techniques offered currently use a hand-sewn duodenoileostomy. This approach is limited by the steep learning curve as well as longer operating times.
- The laparoscopic adjustable gastric band (LAGB) is the most commonly performed restrictive operation for morbid obesity. The LAGB is associated with a mean excess weight loss (EWL) of 50%, as well as a decrease in morbidity and mortality through the resolution of co-morbid conditions, such as diabetes mellitus. Despite these benefits, ≤33% of patients will experience a complication, including port infections or leaks, slippage, pouch dilation, erosion, and food intolerance. Furthermore, nearly 40% of patients will not achieve their target of 50% EWL, necessitating an additional intervention [1–3].
- Biliopancreatic diversion with duodenal switch (BPD-DS) is a bariatric operation with restrictive and malabsorptive effects. It includes sleeve gastrectomy with division of the first portion of the duodenum and reconnection to the distal 250 cm of ileum. The bypassed duodenum, jejunum, and proximal ileum (biliopancreatic limb) are reconnected to create a Y-shaped anatomy with a common channel of 50–150 cm.
- Biliopancreatic diversion (BPD) with duodenal switch (DS) for morbid obesity was first performed by Hess and Hess  in 1988. BPD-DS incorporates two distinct procedures: the BPD, which had been well established by Scopinaro et al.  in 1976 and the DS, established by DeMeester et al. . At 10 years, Hess et al.  reported excellent long-term results in terms of weight loss, with a percentage of excess weight loss (%EWL) of 75% in 92% of the patients followed up, in addition to high patient satisfaction and low complication rates.
- The duodenal switch (DS) is an alternative operation to the Scopinaro biliopancreatic diversion. Hess and Hess  performed the first case in March 1988 in 1 woman with a body mass index (BMI) of 60 kg/m2 and a BMI of 29 kg/m2 17 years later. Marceau et al.  published the first report on the procedure, followed by Baltasar et al. [3,4], who published additional series. Ren et al.  performed the first laparoscopic DS (LDS) in July 1999 and Baltasar et al. [6,7] published the second world experience.