title: A clinical and nutritional comparison of biliopancreatic diversion with and without duodenal switch.
abstract: OBJECTIVE
  To compare biliopancreatic diversion (BPD) without duodenal switch (DS) and with duodenal switch (BPDDS).
  
  
  BACKGROUND
  A reduction of 70% of excess body weight can be achieved after BPD, but there is a risk of malnutrition and diarrhea. This risk may be reduced by pyloric preservation with BPDDS.
  
  
  METHODS
  BPD was performed until 1999, when BPDDS was introduced, both with a common channel of 50 cm. At their latest clinic visit, patients filled in a questionnaire regarding weight loss, dietary history, gastrointestinal symptoms, obesity-related comorbidity, and medication including dietary supplements and underwent a serum nutritional screen.
  
  
  RESULTS
  BPD was performed in 73 patients and BPDDS in 61 patients, with a median preoperative body mass index (BMI) of 44.8 kg/m and a median follow-up of 28 months. There were no significant differences between BPD and BPDDS with regards to age, sex, BMI, or morbidity. Median excess weight loss and BMI at 12, 24, and 36 months was 64.1, 71.0, and 72.1% and 33.1, 31.5, and 31.5 kg/m, respectively; there were no significant differences between BPD and BPDDS. There were no significant differences between BPD and BPDDS with regards to meal size, fat score, nausea, vomiting, diarrhea, or nutritional parameters. However, 18% of patients were hypoalbuminemic, 32% anemic, 25% hypocalcemic, and almost half had low vitamin A, D, and K levels, despite more than 80% taking vitamin supplementation.
  
  
  CONCLUSIONS
  DS does not improve weight loss or lessen the gastrointestinal or nutritional side effects of BPD.
authors.affiliation: Department Of Surgery, Royal Brisbane Hospital, Queensland, Australia. medkd@iprimus.com.au
authors.forename: Kevin
authors.initials: K
authors.lastname: Dolan
authors.forename: Michael
authors.initials: M
authors.lastname: Hatzifotis
authors.forename: Leyanne
authors.initials: L
authors.lastname: Newbury
authors.forename: Nadine
authors.initials: N
authors.lastname: Lowe
authors.forename: George
authors.initials: G
authors.lastname: Fielding
mesh_terms: D000328:Adult; D000368:Aged; D015904:Biliopancreatic Diversion / Q000009:adverse effects / Q000379:methods*; D015992:Body Mass Index; D003967:Diarrhea / Q000209:etiology; D004041:Dietary Fats / Q000008:administration & dosage; D019587:Dietary Supplements; D004386:Duodenum / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D009752:Nutritional Status; D009767:Obesity, Morbid / Q000601:surgery*; D014815:Vitamins / Q000008:administration & dosage; D014839:Vomiting / Q000209:etiology; D015431:Weight Loss
chemical_list: D004041:Dietary Fats; D014815:Vitamins