Is biliopancreatic diversion with duodenal switch indicated for patients with body mass index <50 kg/m2?
BACKGROUND
Biliopancreatic diversion with duodenal switch (DS) has been the standard surgical approach for the treatment of morbidly obese patients at our institution since the early 1990 s. The published data, however, have shown the use of the DS to be limited to the treatment of super-morbidly obese patients (body mass index [BMI] ≥ 50 kg/m(2)). The aim of the present study was to present our long-term results with the DS in patients with an initial BMI of <50 kg/m(2).


METHODS
This was a retrospective study of all patients with a BMI <50 kg/m(2) who had undergone DS from June 1992 to May 2005. The data are reported as the mean ± standard deviation.


RESULTS
The data from 810 consecutive patients, with a mean initial BMI of 44.2 ± 3.6 kg/m(2), were reviewed. The mean follow-up was 103 ± 49 months. Major perioperative complications occurred in 5.8% of patients, including 5 deaths (.6%). The initial excess weight loss was 76% ± 22%, and the excess weight loss was >50% in 89% of patients. Malnutrition required readmission in 4.3% and surgical revision in 1.5%. The prevalence of severe albumin deficiency (<30 g/L) was 1.1%, hemoglobin deficiency (<100 g/L), 1.6%, iron deficiency (<4 mmol/L) 2.1%, and calcium deficiency (<2 g/L) 3%. The percentage of patients "very satisfied" with the global result was 91%, and 37% would have preferred to lose more weight.


CONCLUSIONS
These results showed that in non super-obese patients, DS was very efficient in terms of weight loss and patient satisfaction. This was associated with a 1.5% risk of revision for malnutrition. However, nutritional deficiencies required frequent readjustment of supplements, particularly for calcium, vitamin A, and vitamin D.
Biertho
Laurent
L
Department of Surgery, Division of Bariatric and General Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada. Laurentbiertho@hotmail.com
Biron
Simon
S
Hould
Frederic-Simon
FS
Lebel
Stefane
S
Marceau
Simon
S
Marceau
Picard
P
D000328:Adult; D000418:Albumins / Q000172:deficiency; D015904:Biliopancreatic Diversion / Q000379:methods*; D015992:Body Mass Index; D002118:Calcium / Q000172:deficiency; D016009:Chi-Square Distribution; D015897:Comorbidity; D019587:Dietary Supplements; D004386:Duodenum / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000172:deficiency; D006801:Humans; D000090463:Iron Deficiencies; D008297:Male; D044342:Malnutrition / Q000453:epidemiology; D009767:Obesity, Morbid / Q000601:surgery*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
D000418:Albumins; D006454:Hemoglobins; D002118:Calcium