Long-term outcomes after biliopancreatic diversion with and without duodenal switch: 2-, 5-, and 10-year data

Abstract

BackgroundThere are minimal long-term data on biliopancreatic diversion (BPD) with or without duodenal switch (BPD/DS). ObjectivesTo investigate the long-term weight loss, co-morbidity remission, complications, and quality of life after BPD and BPD/DS. SettingAn academic, university hospital in the United States. MethodsWe 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. ResultsOne 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/m2 versus≥50 kg/m2 and 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. ConclusionThis 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.