title: Long-Term Metabolic Outcomes 5 to 20 Years After Biliopancreatic Diversion.
abstract: BACKGROUND
  Biliopancreatic diversion (BPD) is a complex bariatric operation requiring meticulous surveillance which has impeded its broad adoption. Improvements in surgical care and technique, better teaching programs, and stringent norms for follow-up have contributed to increased safety of BPD for patients with BMI <50, achieving better long-term results than other bariatric operations. Here we report 20-year outcomes of 2615 consecutive patients (median 8) having open BPD with duodenal switch (DS) between 1992 and 2010.
  
  
  METHODS
  Chart of 92 % of patients with complete clinical, biochemical, and physical examinations completed before 2013 was reviewed. The research was conducted at Academic Medical Center, Quebec City.
  
  
  RESULTS
  There was total mortality of 4.7 %, equivalent to that of the general population of Quebec. Incident diabetes (38.8 %) was cured in 93.4 % (blood glucose <6 mmol/l; HbA1c <6.5 %) with 4 % relapse rate after mean 9.6 years with no new cases. Dyslipidemia (24.2 %) was cured in 80 %. Hypertension (60 %) was cured in 64 % and improved in 31 %. Mean weight loss of 55.3 kg (71 % excess weight loss (EWL); 20 BMI units) was maintained for 5 to 20 years. Operative mortality was reduced from 1.3 % in 1992 to 0.2 % during 2005-2010, with cumulated rate surgical mortality of 0.5, revision rate 3, and reoperations in 13 %. Nutritional deficiencies were present in 2 % for calcium, iron, and vitamin A. Side effects were considered minor by the great majority of patients, rating global satisfaction as 4.5/5 (91 % "satisfied").
  
  
  CONCLUSIONS
  BPD deserves more consideration as a primary procedure for eligible patients in experienced centers with sufficient resources for delivering high-quality care and long-term follow-up.
authors: Department of Bariatric Surgery, Quebec, IUCPQ, University Institute Cardiology and Pneumology, Laval University, 2725, Chemin Ste-Foy, Québec, QC, G1V 4G5, Canada, picard.marceau@chg.ulaval.ca.
authors: Picard
authors: P
authors: Marceau
authors: Simon
authors: S
authors: Biron
authors: Simon
authors: S
authors: Marceau
authors: Frederic-Simon
authors: FS
authors: Hould
authors: Stefane
authors: S
authors: Lebel
authors: Odette
authors: O
authors: Lescelleur
authors: Laurent
authors: L
authors: Biertho
authors: Serge
authors: S
authors: Simard
authors: John G
authors: JG
authors: Kral
mesh_terms: D000293:Adolescent; D000368:Aged; D015904:Biliopancreatic Diversion; D003920:Diabetes Mellitus / Q000453:epidemiology; D050171:Dyslipidemias / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery; D063868:Patient Outcome Assessment; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011792:Quebec / Q000453:epidemiology; D015431:Weight Loss; D055815:Young Adult