Iswanto Sucandy, MD, Andres Samayoa, MD, Fernando Bonanni, MD, FACS, Gintaras Antanavicius, MD, FACS. Abington Memorial Hospital, PA.
Roux-en-Y gastric bypass (RYGB) has been challenged by insufficient weight loss and weight regain, especially in superobese patients (BMI >50 kg/m2). These unsatisfactory outcomes frequently lead to revisional procedures, in order to maintain the benefit of initial weight loss. Although biliopancreatic diversion with duodenal switch (BPD-DS) is not the most commonly performed procedure in the United States, it is considered the more effective bariatric procedure than RYGB. Only limited mid-/long-term data can be found in the literature in regards to weight loss outcome and weight regain after laparoscopic BPD-DS. This study is designed to evaluate weight loss outcome and weight regain up to 5 years after laparoscopic BPD-DS.
A review of a prospectively maintained database of 425 patients who underwent laparoscopic BPD-DS from 2006 to 2013 was conducted. The patients were seen in follow-up at 1,3,6,9,12,18 months for the first 2 years postoperatively, and continued yearly thereafter. Weight loss outcome was measured as a percentage of excess weight loss (%EWL).
A total of 425 patients (F:M=309:116) with average age of 44.6 years (range : 20-72), BMI of 50.4 kg/m2 (range : 34.2-78.8) were included in this study. Median length of hospital stay was 4.2 days (range : 1-33). Up to date, 107 of 425 (25.2%) patients have reached 5-year postoperative follow-up interval. Postoperative weight loss data was able to be collected in 71% of patients at 1 year, 45 % of patients at 2 years, and 15% of patients at 5 years. Percentages of postoperative excess weight loss at 1,3,6,9,12,18 months were 20%, 36.7%, 55.1%, 68.5%, 76.6%, 81.8%, respectively. On longer follow-up interval at 2,3,4, and 5 years after the laparoscopic BPD-DS, the patients continued to show excellent results with maintained excess weight loss of 82.2%, 81.9%, 81%, and 83%, respectively.
In our experience, issues of insufficient weight loss and weight regain seen after RYGB do not appear to be a major concern in patients who underwent laparoscopic BPD-DS, despite their high preoperative mean BMI. Laparoscopic BPD-DS maintains its efficacy even after 5 years postoperatively.
Biliopancreatic diversion, Duodenal switch, Weight Loss, Weight Regain