title: Long-term outcomes after biliopancreatic diversion with and without duodenal switch: 2-, 5-, and 10-year data.
abstract: BACKGROUND
  There are minimal long-term data on biliopancreatic diversion (BPD) with or without duodenal switch (BPD/DS).
  
  
  OBJECTIVE
  To investigate the long-term weight loss, co-morbidity remission, complications, and quality of life after BPD and BPD/DS.
  
  
  METHODS
  An academic, university hospital in the United States.
  
  
  METHODS
  We conducted a retrospective review of patients who underwent BPD or BPD/DS between 1999 and 2011. Outcomes included weight loss measures at 2, 5, and 10-15 years postoperatively; co-morbidity remission; long-term complications; nutritional deficiencies; and patient satisfaction.
  
  
  RESULTS
  One hundred patients underwent BPD (34%) or BPD/DS (64%). Mean preoperative body mass index (BMI) was 50.2 kg/m2. Mean follow up was 8.2 years (range: 1-15 yr) with 72% of eligible patients in active follow up at 10-15 years postoperatively. Excess weight loss (EWL) was 65.1% at 2 years, 63.8% at 5 years, and 67.9% at 10-15 years. Approximately 10% higher %EWL was achieved for those with preoperative BMI<50 kg/m2versus≥50 kg/m2and patients who underwent BPD/DS versus BPD. Although co-morbidities improved, 37% of patients developed long-term complications requiring surgery. There were no 30-day mortalities; however, there was one mortality from severe malnutrition. Nutritional deficiencies in fat-soluble vitamins, anemia, and secondary hyperparathyroidism were common. Overall, 94% of patients reported satisfaction with their choice of surgery.
  
  
  CONCLUSIONS
  This clinical experience supports the long-term positive safety profile and efficacy of BPD and BPD/DS at a single U.S. center. Higher levels of excess weight loss are achieved by patients with a lower preoperative BMI and BPD/DS. Although nutritional deficiencies and postoperative complications are common, patient satisfaction remains high.
authors.affiliation: Department of Surgery, New York University School of Medicine, New York, New York. Electronic address: monica.sethi@nyumc.org.
authors.forename: Monica
authors.initials: M
authors.lastname: Sethi
authors.affiliation: Department of Surgery, New York University School of Medicine, New York, New York.
authors.forename: Edward
authors.initials: E
authors.lastname: Chau
authors.affiliation: Department of Surgery, New York University School of Medicine, New York, New York.
authors.forename: Allison
authors.initials: A
authors.lastname: Youn
authors.affiliation: Department of Surgery, New York University School of Medicine, New York, New York.
authors.forename: Yan
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Department of Surgery, New York University School of Medicine, New York, New York.
authors.forename: George
authors.initials: G
authors.lastname: Fielding
authors.affiliation: Department of Surgery, New York University School of Medicine, New York, New York.
authors.forename: Christine
authors.initials: C
authors.lastname: Ren-Fielding
mesh_terms: D000328:Adult; D000368:Aged; D015904:Biliopancreatic Diversion / Q000009:adverse effects / Q000379:methods*; D004386:Duodenum / Q000601:surgery*; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008286:Malabsorption Syndromes / Q000209:etiology; D008297:Male; D044342:Malnutrition / Q000209:etiology; D008875:Middle Aged; D009752:Nutritional Status; D009767:Obesity, Morbid / Q000601:surgery; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology; D055815:Young Adult
keywords: Bariatric surgery; Biliopancreatic diversion; Duodenal switch; Long-term outcomes; Malabsorptive