Obesity Surgery

, Volume 24, Issue 11, pp 1843–1849

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

  • Picard Marceau
  • Simon Biron
  • Simon Marceau
  • Frederic-Simon Hould
  • Stefane Lebel
  • Odette Lescelleur
  • Laurent Biertho
  • John G. Kral
Original Contributions

DOI: 10.1007/s11695-014-1284-0

Cite this article as:
Marceau, P., Biron, S., Marceau, S. et al. OBES SURG (2014) 24: 1843. doi:10.1007/s11695-014-1284-0

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.

Keywords

Severe obesity Cirrhosis Staged surgery Metabolic surgery Intestinal diversion Sleeve gastrectomy Duodenal switch 

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Picard Marceau
    • 1
  • Simon Biron
    • 1
  • Simon Marceau
    • 1
  • Frederic-Simon Hould
    • 1
  • Stefane Lebel
    • 1
  • Odette Lescelleur
    • 1
  • Laurent Biertho
    • 1
  • John G. Kral
    • 2
  1. 1.Department of Bariatric Surgery, Quebec, Laval Hospital, IUCPQUniversity Institute Cardiology and PneumologyQuébecCanada
  2. 2.Department of Surgery, Downstate Medical Center Brooklyn, New YorkState University of New YorkBrooklynUSA

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