Long-Term Metabolic Outcomes 5 to 20 Years After Biliopancreatic Diversion

Abstract

Background

Biliopancreatic diversion (BPD) is a complex bariatric operation requiring meticulous surveillance which has impeded its broad adoption. Improvements in surgical care and technique, better teaching programs, and stringent norms for follow-up have contributed to increased safety of BPD for patients with BMI <50, achieving better long-term results than other bariatric operations. Here we report 20-year outcomes of 2615 consecutive patients (median 8) having open BPD with duodenal switch (DS) between 1992 and 2010.

Methods

Chart of 92 % of patients with complete clinical, biochemical, and physical examinations completed before 2013 was reviewed. The research was conducted at Academic Medical Center, Quebec City.

Results

There was total mortality of 4.7 %, equivalent to that of the general population of Quebec. Incident diabetes (38.8 %) was cured in 93.4 % (blood glucose <6 mmol/l; HbA1c <6.5 %) with 4 % relapse rate after mean 9.6 years with no new cases. Dyslipidemia (24.2 %) was cured in 80 %. Hypertension (60 %) was cured in 64 % and improved in 31 %. Mean weight loss of 55.3 kg (71 % excess weight loss (EWL); 20 BMI units) was maintained for 5 to 20 years. Operative mortality was reduced from 1.3 % in 1992 to 0.2 % during 2005–2010, with cumulated rate surgical mortality of 0.5, revision rate 3, and reoperations in 13 %. Nutritional deficiencies were present in 2 % for calcium, iron, and vitamin A. Side effects were considered minor by the great majority of patients, rating global satisfaction as 4.5/5 (91 % “satisfied”).

Conclusions

BPD deserves more consideration as a primary procedure for eligible patients in experienced centers with sufficient resources for delivering high-quality care and long-term follow-up.

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Acknowledgment

The authors would like to acknowledge Paule Marceau, Databank manager, who assisted us the data collection.

Authors’ contributions

Picard Marceau and Simon Marceau have full access to all of the data and take responsibility for the integrity and accuracy of the data. John G. Kral, co-writer supervisor, was participated in the conception, revision, and approval of the study. Biron S., Hould F.S., Lebel S., Lescelleur O., and Biertho L., bariatric surgeons, were participated in the revision and approval of the study. Simard S. was the research statistician from IUCPQ Research Center.

Conflict of Interest

All authors have no financial relationships relevant to this article to disclose.

A Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study. Databank and its use for research have been accepted by the Laval University, University Institute of Cardiology and Pneumology of Quebec (IUCPQ).

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Correspondence to Picard Marceau.

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Marceau, P., Biron, S., Marceau, S. et al. Long-Term Metabolic Outcomes 5 to 20 Years After Biliopancreatic Diversion. OBES SURG 25, 1584–1593 (2015). https://doi.org/10.1007/s11695-015-1599-5

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Keywords

  • Duodenal switch
  • Bariatric surgery
  • Metabolic surgery
  • Outcomes
  • “Health care delivery”