BILIOPANCREATIC DIVERSION WITH A DUODENAL SWITCH

Background: This paper evaluates biliopancreatic diversion combined wi th the duodenal switch, forming a hybrid procedure which is a combinat ion of restriction and malabsorption. Methods: The evaluation is of th e first 440 patients undergoing this procedure who had had no previous bariatric surgery. The mean starting weight was 183 kg, with 41% of o ur patients considered super morbidly obese (BMI > 50). Results: There was an average maximum weight loss of 80% excess weight by 24 months post-operation; this continued at a 70% level for 8 years. Major compl ications were found in almost 9% of the cases. There were two perioper ative deaths, one from pulmonary embolism and one from acute pulmonary obstruction. There were 36 type II diabetics, all of whom have discon tinued medication following the surgery. Seventeen revisions were perf ormed to correct excess weight loss and low protein levels. There have been no marginal ulcers, no cases of dumping syndrome, no foreign mat erial used, and the procedure is a pyloric saving procedure which is f unctionally reversible. Conclusions: This operation has vastly improve d the lives of seriously obese patients with many comorbidities. All t ype II diabetics have essentially been cured of their disease. The pro cedure was tolerated well and patients are quite satisfied. There was minimal regain of weight with this method, (C) 1998 Lippincott-Raven P ublishers.