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Should biliopancreatic diversion with duodenal switch be done as single-stage procedure in patients with BMI > or = 50 kg/m2?
Surg Obes Relat Dis. 2010 Jan-Feb; 6(1):59-63.SO

Abstract

BACKGROUND

Biliopancreatic diversion with or without the duodenal switch (BPD-DS) is a major bariatric procedure. The morbidity and mortality are likely to increase with an increasing body mass index (BMI), especially when > 50 kg/m(2). Controversy exists regarding the potentially increased risks of a single-stage procedure compared with the risks of sleeve gastrectomy first followed by the malabsorptive procedure after an initial weight loss.

METHODS

From March 2003 to October 2008, 90 patients with a BMI > or = 50 kg/m(2) were candidates for single-stage BPD-DS. Two study periods were identified: before and after February 2007, corresponding to the periods during and after the learning curve. The results were analyzed globally and by comparing the 2 periods using Fisher's exact test and the t test for unpaired values.

RESULTS

Of the 90 patients, 79 were women, the average BMI was 55.2 +/- 4.7 kg/m(2), 13 patients were super-super obese, and 4 patients underwent laparoscopic sleeve gastrectomy only. Of the 86 patients who underwent single-stage BPD-DS, 37 underwent surgery before (31 laparoscopically; group 1) and 49 after (48 laparoscopically; group 2) February 2007. BPD-DS was done as revision surgery for 14 patients with a failed restrictive procedure. The global rate of conversion to open surgery was 13.9%; 35.5% for group 1 versus 2% for group 2 (P = .0001). The morbidity decreased significantly between the 2 periods, with a rate of 16.3% for group 2 compared with 45.9% for group 1. Also, 1 postoperative death occurred in group 1.

CONCLUSION

Single-stage BPD-DS in the super obese appears to be a relatively safe procedure with a low rate of conversion when a laparoscopic approach is used. Although from the published data, the morbidity and mortality are increased for super obese patients, especially men, the BMI itself cannot be considered a contraindication for single-stage BPD-DS, because other factors such as surgical experience also influence the outcome. Despite these variables, performing a sleeve gastrectomy first should be considered for heavier, male, and at-risk patients.

Authors+Show Affiliations

Société de Chirurgie Viscérale, Clinique de l'Anjou, Angers, France. philippetopart@wanadoo.frNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19640795

Citation

Topart, Philippe, et al. "Should Biliopancreatic Diversion With Duodenal Switch Be Done as Single-stage Procedure in Patients With BMI > or = 50 Kg/m2?" Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, vol. 6, no. 1, 2010, pp. 59-63.
Topart P, Becouarn G, Ritz P. Should biliopancreatic diversion with duodenal switch be done as single-stage procedure in patients with BMI > or = 50 kg/m2? Surg Obes Relat Dis. 2010;6(1):59-63.
Topart, P., Becouarn, G., & Ritz, P. (2010). Should biliopancreatic diversion with duodenal switch be done as single-stage procedure in patients with BMI > or = 50 kg/m2? Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, 6(1), 59-63. https://doi.org/10.1016/j.soard.2009.04.016
Topart P, Becouarn G, Ritz P. Should Biliopancreatic Diversion With Duodenal Switch Be Done as Single-stage Procedure in Patients With BMI > or = 50 Kg/m2. Surg Obes Relat Dis. 2010;6(1):59-63. PubMed PMID: 19640795.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Should biliopancreatic diversion with duodenal switch be done as single-stage procedure in patients with BMI > or = 50 kg/m2? AU - Topart,Philippe, AU - Becouarn,Guillaume, AU - Ritz,Patrick, Y1 - 2009/05/13/ PY - 2009/02/09/received PY - 2009/03/27/revised PY - 2009/04/28/accepted PY - 2009/7/31/entrez PY - 2009/7/31/pubmed PY - 2010/6/2/medline SP - 59 EP - 63 JF - Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery JO - Surg Obes Relat Dis VL - 6 IS - 1 N2 - BACKGROUND: Biliopancreatic diversion with or without the duodenal switch (BPD-DS) is a major bariatric procedure. The morbidity and mortality are likely to increase with an increasing body mass index (BMI), especially when > 50 kg/m(2). Controversy exists regarding the potentially increased risks of a single-stage procedure compared with the risks of sleeve gastrectomy first followed by the malabsorptive procedure after an initial weight loss. METHODS: From March 2003 to October 2008, 90 patients with a BMI > or = 50 kg/m(2) were candidates for single-stage BPD-DS. Two study periods were identified: before and after February 2007, corresponding to the periods during and after the learning curve. The results were analyzed globally and by comparing the 2 periods using Fisher's exact test and the t test for unpaired values. RESULTS: Of the 90 patients, 79 were women, the average BMI was 55.2 +/- 4.7 kg/m(2), 13 patients were super-super obese, and 4 patients underwent laparoscopic sleeve gastrectomy only. Of the 86 patients who underwent single-stage BPD-DS, 37 underwent surgery before (31 laparoscopically; group 1) and 49 after (48 laparoscopically; group 2) February 2007. BPD-DS was done as revision surgery for 14 patients with a failed restrictive procedure. The global rate of conversion to open surgery was 13.9%; 35.5% for group 1 versus 2% for group 2 (P = .0001). The morbidity decreased significantly between the 2 periods, with a rate of 16.3% for group 2 compared with 45.9% for group 1. Also, 1 postoperative death occurred in group 1. CONCLUSION: Single-stage BPD-DS in the super obese appears to be a relatively safe procedure with a low rate of conversion when a laparoscopic approach is used. Although from the published data, the morbidity and mortality are increased for super obese patients, especially men, the BMI itself cannot be considered a contraindication for single-stage BPD-DS, because other factors such as surgical experience also influence the outcome. Despite these variables, performing a sleeve gastrectomy first should be considered for heavier, male, and at-risk patients. SN - 1878-7533 UR - https://www.unboundmedicine.com/medline/citation/19640795/Should_biliopancreatic_diversion_with_duodenal_switch_be_done_as_single_stage_procedure_in_patients_with_BMI_>_or_=_50_kg/m2 L2 - https://linkinghub.elsevier.com/retrieve/pii/S1550-7289(09)00459-6 DB - PRIME DP - Unbound Medicine ER -