title: Perioperative complications in a consecutive series of 1000 duodenal switches.
abstract: BACKGROUND
  In the past 10 years, most bariatric surgeries have seen an important reduction in the early complication rate, partly associated with the development of the laparoscopic approach. Our objective was to assess the current early complication rate associated with biliopancreatic diversion with duodenal switch (BPD-DS) since the introduction of a laparoscopic approach in our institution, a university-affiliated tertiary care center.
  
  
  METHODS
  A consecutive series of 1000 patients who had undergone BPD-DS from November 2006 to January 2010 was surveyed. The primary endpoint was the mortality rate. The secondary endpoints were the major 30-day complication rate and hospital stay >10 days. The data are reported as a mean ± SD, comparing the laparoscopic (n = 228) and open (n = 772) groups.
  
  
  RESULTS
  The mean age of the patients was 43 ± 10 years (40 ± 10 years in the laparoscopy group versus 44 ± 10 years in the open group, P < .01). The preoperative body mass index was 51 ± 8 kg/m(2) (47 ± 7 laparoscopy versus 52 ± 8 kg/m(2) open, P < .01). The conversion rate in the laparoscopy group was 2.6%. There was 1 postoperative death (.1%) from a pulmonary embolism in the laparoscopy group. The mean hospital stay was shorter after laparoscopic surgery (6 ± 6 d versus 7 ± 9 d, P = .01), and a hospital stay >10 days was more frequent in the open group (4.4% versus 7%, P = .04). Major complications occurred in 7% of the patients, with no significant differences between the 2 groups (7% versus 7.4%, P = .1). No differences were found in the overall leak or intra-abdominal abscess rate (3.5% versus 4%, P = .1); however, gastric leaks were more frequent after open surgery (0% versus 2%, P = .02). During a mean 2-year follow-up, 1 additional death occurred from myocardial infarction, 2 years after open BPD-DS.
  
  
  CONCLUSIONS
  The early and late mortality rate of BPD-DS is low and comparable to that of other bariatric surgeries.
authors.affiliation: Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada. laurentbiertho@hotmail.com
authors.forename: Laurent
authors.initials: L
authors.lastname: Biertho
authors.forename: Stéfane
authors.initials: S
authors.lastname: Lebel
authors.forename: Simon
authors.initials: S
authors.lastname: Marceau
authors.forename: Frédéric-Simon
authors.initials: FS
authors.lastname: Hould
authors.forename: Odette
authors.initials: O
authors.lastname: Lescelleur
authors.forename: Fady
authors.initials: F
authors.lastname: Moustarah
authors.forename: Serge
authors.initials: S
authors.lastname: Simard
authors.forename: Simon
authors.initials: S
authors.lastname: Biron
authors.forename: Picard
authors.initials: P
authors.lastname: Marceau
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D015904:Biliopancreatic Diversion / Q000009:adverse effects* / Q000379:methods; D016022:Case-Control Studies; D004386:Duodenum / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery; D012086:Reoperation; D015431:Weight Loss