A clinical and nutritional comparison of biliopancreatic diversion with and without duodenal switch.
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.
Dolan
Kevin
K
Department Of Surgery, Royal Brisbane Hospital, Queensland, Australia. medkd@iprimus.com.au
Hatzifotis
Michael
M
Newbury
Leyanne
L
Lowe
Nadine
N
Fielding
George
G
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
D004041:Dietary Fats; D014815:Vitamins