title: Early results after introduction of biliopancreatic diversion/duodenal switch at a military bariatric center.
abstract: BACKGROUND
  Biliopancreatic diversion with duodenal switch (BPD/DS) is one of the most effective procedures in terms of weight loss and durability. It is also one of the most complex and highest risk bariatric procedures. The authors report their initial experience with BPD/DS.
  
  
  METHODS
  A retrospective review of all patients undergoing BPD/DS was performed, including a descriptive analysis of demographics, operative data, complications, and outcomes. Results were also compared with those among a group of 100 patients undergoing laparoscopic gastric bypass (LGB).
  
  
  RESULTS
  Forty-three patients were identified. Mean preoperative body mass index was 52 kg/m(2), and 56% of patients had body mass indexes > 50 kg/m(2). Twenty (47%) were attempted laparoscopically, with 5 (25%) requiring conversion to open approach. Overall mean operative time was 269 minutes, with no significant difference between laparoscopic (256 minutes) and open (280 minutes). No major intraoperative complications occurred. Major postoperative complications included 4 gastric sleeve leaks, 2 small bowel obstructions, 1 intra-abdominal hemorrhage, and 1 duodenal stump leak. There was 1 death. Mean percentage excess body weight loss was 85% at 1 year. No patients developed severe malabsorptive symptoms or evidence of protein malnutrition. BPD/DS was associated with longer operative times and higher complication rates (P < .05 for both) compared with LGB but had significantly greater weight loss at 1 year (P < .05).
  
  
  CONCLUSIONS
  BPD/DS is a complex procedure associated with increased operative times, increased risk for conversion from laparoscopic to open approach, and higher postoperative complication rates. However, it results in significantly greater weight loss than LGB without major adverse nutritional impact.
authors.affiliation: Department of Surgery, Madigan Army Medical Center, Fort Lewis, WA 98431, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Nelson
authors.forename: Alec
authors.initials: A
authors.lastname: Beekley
authors.forename: Preston
authors.initials: P
authors.lastname: Carter
authors.forename: Randy
authors.initials: R
authors.lastname: Kjorstad
authors.forename: James
authors.initials: J
authors.lastname: Sebesta
authors.forename: Matthew
authors.initials: M
authors.lastname: Martin
mesh_terms: D000328:Adult; D015904:Biliopancreatic Diversion / Q000379:methods*; D015992:Body Mass Index; D004386:Duodenum / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects*; D006772:Hospitals, Military; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D013531:Surgicenters; D013997:Time Factors; D017211:Treatment Failure; D014861:Washington; D015431:Weight Loss