Is laparoscopic single-stage biliopancreatic diversion with duodenal switch safe in super morbidly obese patients?
BACKGROUND
It has been hypothesized that the morbidity and mortality of laparoscopic biliopancreatic diversion with duodenal switch (BPD-DS) are likely to increase with increasing body mass index (BMI), especially with BMI>50 kg/m(2). Therefore, a 2-stage approach to this procedure has been advocated in super morbidly obese patients. The authors hypothesized that a BMI ≥ 50 kg/m(2) does not significantly influence the morbidity and mortality perioperatively associated with this procedure.


METHODS
A retrospective analysis of all patients who underwent laparoscopic BPD-DS between January 2009 and September 2011 was performed. The patients were divided into 2 groups: patients with BMI<50 kg/m(2) and those with BMI>50 kg/m(2). Patient characteristics, perioperative variables, 30-day outcomes, and complications were analyzed and compared.


RESULTS
A total of 226 patients underwent laparoscopic BPD-DS. Mean patient age was 44.9 years (range: 20-72 yr). Male to female ratio was 59 to 170 patients (75% versus 25%), respectively. Mean BMI was 50.2 kg/m(2) (range: 37.2-68.8 kg/m(2)). A total of 127 patients had a BMI<50 kg/m(2) (Group 1), and 99 patients had a BMI ≥ 50 kg/m(2) (Group 2). The length of procedure in Groups 1 and 2 was 296 minutes and 287 minutes, respectively (P = .25). The rate of conversion to open BPD-DS was 1.5% in Group 1 and 3% in Group 2 (P = .65). Two leaks occurred in Group 1; no patient in Group 2 developed this complication. One patient in Group 2 developed pulmonary embolism. The rates of all other complications resulting in a longer length of stay were 11% in Group 1 and 8% in Group 2 (P = .50). The 30-day reoperation rate was 3% in Group 1 and 1% in Group 2 (P = .39). The mean length of stay was 3.97 days for Group 1 and 3.67 days for Group 2 (P = .34). No mortality occurred in this series.


CONCLUSIONS
In the present study, BMI ≥ 50 kg/m(2) did not increase intraoperative or postoperative complications at 30 days after laparoscopic PBD-DS. No significant differences were noted between patients with BMI ≥ 50 kg/m(2) and patients with BMI<50 kg/m(2). A single-stage laparoscopic BPD-DS procedure can be safely offered to the super morbidly obese patients.
Department of Surgery, Institute for Bariatric and Metabolic Surgery, Abington Memorial Hospital, Abington, Pennsylvania. Electronic address: masrezvani@gmail.com.
Masoud
M
Rezvani
Department of Surgery, Institute for Bariatric and Metabolic Surgery, Abington Memorial Hospital, Abington, Pennsylvania.
Iswanto
I
Sucandy
Department of Surgery, Institute for Bariatric and Metabolic Surgery, Abington Memorial Hospital, Abington, Pennsylvania.
Amarita
A
Klar
Department of Surgery, Institute for Bariatric and Metabolic Surgery, Abington Memorial Hospital, Abington, Pennsylvania.
Fernando
F
Bonanni
Department of Surgery, Institute for Bariatric and Metabolic Surgery, Abington Memorial Hospital, Abington, Pennsylvania.
Gintaras
G
Antanavicius
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D015904:Biliopancreatic Diversion / Q000379:methods*; D004386:Duodenum / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D010414:Pennsylvania / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology*; D055815:Young Adult
Body mass index; One-stage laparoscopic biliopancreatic diversion with duodenal switch