Early results of laparoscopic biliopancreatic diversion with duodenal switch: A case series of 40 consecutive patients

Background: Biliopancreatic diversion with duodenal switch (BPD-DS) is an o peration which provides one of the greatest maintained weight losses of any bariatric procedure. We looked at the safety and efficacy of laparoscopic BPD-DS for morbid obesity. Methods: A 150-200 mi sleeve gastrectomy was created and anastomosed to the distal 250 cm of divided ileum. The median length of the common channel wa s 100 cm. All patients were prospectively followed up to 12 months. Results: 40 consecutive patients underwent laparoscopic BPD-DS as a primary procedure for morbid obesity. Median patient body mass index (BMI) was 60 kg/m(2) (range 42-85 kg/m(2)). Mean age was 43 +/- 1 years (+/- SEM), with 12 males and 28 females. One patient was converted to open laparotomy (2.5% ). Median operative time was 210 +/- 9 minutes (range 110-360 minutes) with a significant correlation between BMI and operative time (p = 0.04). Media n length of stay was 4 days (range 3 - 210 days). There was one 30-day mort ality(2.5%). Major morbidities occurred in 6 patients (15%), including 1 an astomotic leak (2.5%), 1 venous thrombosis (2.5%), 4 staple-line hemorrhage s (10%) and 1 subphrenic abscess (2.5%). Median follow-up at 6 months (rang e 1-12 months) resulted in 46% +/- 2% excess weight loss (EWL) and at 9 mon ths 58% +/- 3% EWL. Conclusion: Laparoscopic BPD-DS is a complex, yet feasible, procedure resul ting in effective weight loss with an acceptable morbidity. A BMI >65 was a ssociated with increased morbidity and mortality. A long-term study is need ed to confirm efficacy and proper patient selection.