Long-term Outcome after Biliopancreatic Diversion with Duodenal Switch: A Single-Center Experience with up to 20 Years Follow-up


Background

Biliopancreatic diversion with duodenal switch (BPD/DS) is the most effective standard
bariatric procedure in terms of weight loss and remission of comorbidities but carries
the risk of severe long-term side effects.

Objectives

The aim of this study was to analyze the long-term effects of BPD/DS in terms of morbidity,
weight loss, remission of associated medical problems, deficiencies and reoperations.

Setting

XXX – blinded for review purposes

Methods

This is a retrospective, single-center study of prospectively collected data of all
patients who underwent BPD/DS from 1999 to 2011 with a minimal follow-up (FU) of ten
years.

Results

116 patients (83.6% female) underwent BPD/DS with a mean initial body mass index (BMI)
of 47±6.5 kg/m2. 68% of the procedures were performed in open technique and 32% laparoscopically.
76.7% of patients had laparoscopic adjustable gastric banding (LAGB) prior to BPD/DS.
Mean FU time was 14±4.4 years and FU rate at 5, 10 and 14 years was 95.6% (n = 108),
90% (n=98) and 75.3% (n=70). Mean excess BMI loss (%EBMIL) at 5, 10 and 14 years was
78±24.1%, 76.5±26.7% and 77.8±33.8%, respectively. Complete (n=22) or partial remission
(n=4) of type 2 diabetes mellitus (T2D) was observed in 92.8% of patients. Forty reoperations
were necessary in 34 patients (29.3%) due to malnutrition or refractory diarrhea (n=13),
insufficient weight loss or weight rebound (n=7), reflux or stenosis (n=10) and various/combined
indications (n=10). Mean time to reoperation was 7.7±5 years. There were no procedure-related
deaths in the short- or long-term.

Conclusion

BPD/DS offers a sustainable long-term weight loss but is associated with important
side effects that may be acceptable in selected patients with a high initial BMI (>50kg/m2) and / or for non-responders after primary restrictive procedures. Regular FU is
necessary to detect and treat malnutrition and vitamin deficiencies.



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