Robotically-Assisted Laparoscopic Biliopancreatic Diversion with Duodenal Switch. Learning Curve and Progress in Five Years of Practice

Iswanto Sucandy, MD, Gintaras Antanavicius, MD, FACS. Abington Memorial Hospital, PA.

Introduction: Laparoscopic biliopancreatic diversion with duodenal switch (BPD/DS) is the most technically challenging procedure in bariatric surgery. This procedure has been shown to result in better resolution of diabetes mellitus, hypertension, and hypercholesterolemia, as well as more sustained weight loss compared to gastric banding or RY gastric bypass. Advanced minimal access skills and a significant learning curve are required to achieve optimal outcomes. This study was designed to evaluate our progress with this procedure over the past 5 years of bariatric practice.

Materials and Methods: A prospectively-maintained database of all patients who underwent robotically-assisted laparoscopic BPD/DS between 2008 and 2013 was reviewed. Patients were divided into the following two groups (Group A – the initial 90 patients, and Group B – the last 89 patients). Perioperative outcomes and complications between the two groups were compared, using student T-test. P-value of <.05 is considered statistically significant.

Results: A total of 179 consecutive patients (F:M=137:42) were included in the study. Group A patients had an average age of 44.7 years (range: 20-67), BMI of 50.7 kg/m2 (range: 37.4-70), and 6.3 obesity-related comorbidities (range: 2-12). Group B patients had an average age of 43.6 years (range: 21-72), BMI of 49.9 kg/m2 (range: 35-78.8), and 6.9 comorbidities (range: 3-14). Within 5 years, our mean operative time decreased from 285 minutes (Group A) to 235 minutes (Group B). All cases were completed using a robotically-assisted approach, with no major intraoperative complications in either group. Two patients in Group A returned to the operating room: one for endoscopic release of an inadvertently-sutured nasogastric tube and another for port-site infection. Three patients in Group A were readmitted within 30 days of discharge due to fluid retention, incarcerated ventral hernia, and gastrointestinal bleeding, respectively, while one patient in Group B was readmitted for deep venous thrombosis and pulmonary embolism. Average length of hospital stay was also shorter in the later group (2.3 vs 3.1 days, p-value >.05). Comparable weight loss at 1,3,6,9,12,18,24,and 36 months postoperatively were achieved by both groups. No mortality occurred in this series.

Conclusions: Within 5 years of experience performing robotically-assisted laparoscopic BPD/DS, our outcomes have improved, as reflected by shorter operative time, lower rate of reoperation, and shorter duration of hospital stay.

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