Safety of biliopancreatic diversion with duodenal switch in patients with body mass index less than 50kg/m2.

Abstract

Biliopancreatic diversion with duodenal switch (BPD-DS) has often been reserved for patients with BMI > 50kg/m2. We aim to assess the safety of BPD-DS in patients with morbid obesity (BMI 335kg/m2 and < 50kg/m2) using a 150-cm common channel (CC), 150-cm Roux limb, and 60-fr bougie. A retrospective review was performed on patients with a BMI < 50mg/k2 who underwent a BPD-DS in 2016-2019 at a single institution. Limb lengths were measured with a laparoscopic instrument with minimal tension. Sleeve gastrectomy was created with 60-fr bougie. Variables were compared using paired t test, Chi-square analysis or repeated measures ANOVA where appropriate. Forty-five patients underwent BPD-DS. CC lengths and Roux limb lengths were 158 ± 20cm and 154 ± 18cm, respectively. Preoperative BMI was 44.9 ± 2.3kg/m2 and follow-up was 2.7 ± 1.4years. One patient required reoperation for bleeding and died from multiorgan failure and delayed sleeve leak. There was 1 (2.2%) readmission for contained anastomotic leak and 2 ED visits (4.5%) within 30days. There were no marginal ulcers, limb length revisions, or need for parental nutrition. Percent excess weight loss was 67.2 ± 19.7%. 88.9% (N = 8), 86.6% (N = 13), and 55.5% (N = 5) of patients had resolution or improvement of their diabetes mellitus type II, hypertension, and hyperlipidemia, respectively. 40% (N = 4) of patients had resolution of their gastroesophageal reflux disease (GERD) and 11.4% (N = 5) developed de novo GERD. 32% (N = 14) of patients had vitamin D deficiency and 25% (N = 11) experienced zinc deficiency. BPD-DS may be considered in patients with BMI < 50kg/m2 with 150-cm CC, 150-cm Roux limb, and a 60-fr bougie sleeve gastrectomy. There was sustained weight loss and no protein calorie malnutrition, but Vitamin D and zinc deficiency remained a challenge. Careful patient selection and proper counseling of the risks and benefits are necessary.