Biliopancreatic diversion-duodenal switch: independent contributions of sleeve resection and duodenal exclusion.
BACKGROUND
The choice of first-stage operation in bilio-pancreatic diversion with duodenal switch (BPD-DS) is controversial. There are no published long-term comparisons of one- and two-stage BPD-DS outcomes.


METHODS
During 2001-2009, among 1,762 patients scheduled for BPD-DS 48 had duodenal switch (DS) and 53 sleeve gastrectomy (SG) as first-stage procedures. We compared prospectively updated outcomes of 42 DS (100 % open) and 49 SG (88 % laparoscopic), 13 of whom completed their second stage, to a control group of 91 patients with open one-stage BPD-DS.


RESULTS
One-year mean percent excess weight loss (%EWL) was greater after SG than DS (47 ± 19 vs. 39 ± 13 SD; p = 0.01) with earlier nadir (16 ± 10 vs. 45 ± 30 months; p < 0.0001) but more rapid significant weight regain. After 5 years, %EWL was 12 ± 35 for 9 SG, 45 ± 19 for 30 DS (p < 0.0006), and 70 ± 18 for the first-stage BPD-DS (p < 0.0001). Weight loss was less after two- than one-stage procedures (p < 0.02). Comorbidities improved progressively between SG, DS and BPD-DS (p < 0.001 for trend). HbA1C decreased by 10, 19, and 31 %, respectively (p < 0.0001). Dyslipidemia was cured in 41, 82, and 100 %, respectively. Systolic and diastolic blood pressure decreased only after DS (12 %; p < 0.0002). Patient satisfaction was similar for SG and DS but greater after BPD-DS overall (p = 0.04).


CONCLUSIONS
SG and DS independently contribute to beneficial metabolic outcomes after BPD-DS. Long-term weight loss and correction of metabolic abnormalities were better after DS favoring its use as first stage in BPD-DS; one-stage BPD-DS outcomes were superior to two-staged.
Department of Bariatric Surgery, Quebec, Laval Hospital, IUCPQ, University Institute Cardiology and Pneumology, Laval University 2725, Chemin Ste-Foy, Québec, QC, G1V 4G5, Canada, picard.marceau@chg.ulaval.ca.
Picard
P
Marceau
Simon
S
Biron
Simon
S
Marceau
Frederic-Simon
FS
Hould
Stefane
S
Lebel
Odette
O
Lescelleur
Laurent
L
Biertho
John G
JG
Kral
D000328:Adult; D015904:Biliopancreatic Diversion / Q000379:methods*; D003657:Decision Making; D004386:Duodenum / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D015431:Weight Loss