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Biliopancreatic Diversion-Duodenal Switch: Independent Contributions of Sleeve Resection and Duodenal Exclusion

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Abstract

Background

The choice of first-stage operation in bilio-pancreatic diversion with duodenal switch (BPD-DS) is controversial. There are no published long-term comparisons of one- and two-stage BPD-DS outcomes.

Methods

During 2001–2009, among 1,762 patients scheduled for BPD-DS 48 had duodenal switch (DS) and 53 sleeve gastrectomy (SG) as first-stage procedures. We compared prospectively updated outcomes of 42 DS (100 % open) and 49 SG (88 % laparoscopic), 13 of whom completed their second stage, to a control group of 91 patients with open one-stage BPD-DS.

Results

One-year mean percent excess weight loss (%EWL) was greater after SG than DS (47 ± 19 vs. 39 ± 13 SD; p = 0.01) with earlier nadir (16 ± 10 vs. 45 ± 30 months; p < 0.0001) but more rapid significant weight regain. After 5 years, %EWL was 12 ± 35 for 9 SG, 45 ± 19 for 30 DS (p < 0.0006), and 70 ± 18 for the first-stage BPD-DS (p < 0.0001). Weight loss was less after two- than one-stage procedures (p < 0.02). Comorbidities improved progressively between SG, DS and BPD-DS (p < 0.001 for trend). HbA1C decreased by 10, 19, and 31 %, respectively (p < 0.0001). Dyslipidemia was cured in 41, 82, and 100 %, respectively. Systolic and diastolic blood pressure decreased only after DS (12 %; p < 0.0002). Patient satisfaction was similar for SG and DS but greater after BPD-DS overall (p = 0.04).

Conclusions

SG and DS independently contribute to beneficial metabolic outcomes after BPD-DS. Long-term weight loss and correction of metabolic abnormalities were better after DS favoring its use as first stage in BPD-DS; one-stage BPD-DS outcomes were superior to two-staged.

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Acknowledgments

We are grateful to Paule Marceau research Assistant and databank coordinator for her major contribution in the realization of this manuscript.

Disclosure

The authors have no commercial associations that might be a conflict of interest in relation to this article.

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Authors and Affiliations

  1. Department of Bariatric Surgery, Quebec, Laval Hospital, IUCPQ, University Institute Cardiology and Pneumology, Laval University 2725, Chemin Ste-Foy, Québec, QC, G1V 4G5, Canada

    Picard Marceau, Simon Biron, Simon Marceau, Frederic-Simon Hould, Stefane Lebel, Odette Lescelleur & Laurent Biertho

  2. Department of Surgery, Downstate Medical Center Brooklyn, New York, State University of New York, Brooklyn, NY, USA

    John G. Kral

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  1. Picard Marceau
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  2. Simon Biron
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  3. Simon Marceau
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  7. Laurent Biertho
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Correspondence to Picard Marceau.

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Marceau, P., Biron, S., Marceau, S. et al. Biliopancreatic Diversion-Duodenal Switch: Independent Contributions of Sleeve Resection and Duodenal Exclusion. OBES SURG 24, 1843–1849 (2014). https://doi.org/10.1007/s11695-014-1284-0

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  • DOI: https://doi.org/10.1007/s11695-014-1284-0

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