Does Preoperative Diabetes Mellitus Affect Weight Loss Outcome After Biliopancreatic Diversion with Duodenal Switch?

Iswanto Sucandy, MD, Gintaras Antanavicius, MD, FACS

Abington Memorial Hospital, Department of Surgery

Introduction: Studies have shown significant association between increased body mass index (BMI) and insulin resistance. Preoperative diabetes mellitus (DM) has been reported as an independent predictor for suboptimal (≤40%) weight loss after Roux-en-Y gastric bypass (RYGB). Association between preoperative DM and weight loss outcome after biliopancreatic diversion with duodenal switch (BPD/DS) has not been investigated. Since only a few centers in the US perform BPD/DS, outcome data regarding this procedure are limited. We designed a study to investigate if preoperative DM similarly affects weight loss outcome after BPD/DS, as reported with RYGB.

Methods: A prospectively maintained database of consecutive patients who underwent robotically-assisted laparoscopic BPD/DS from 2008 to 2012 was reviewed. A total of 152 consecutive patients comprised the study: 51 patients with preoperative DM (Group 1) and 101 patients without DM (Group 2). The weight loss outcomes between the two groups were compared.

Results: Of the 51 patients in Group 1, the mean age was 47.8 years (range: 23-72) and BMI was 47.2 kg/m2 (range: 35-70). The 101 patients in Group 2 had mean age of 42.4 years (range: 20-69) and BMI of 51.3 kg/m2 (range: 37.2-68.8). Gender distribution and mean operative time (269 vs 263 minutes) were comparable between the two groups. All study cases were completed using a minimally invasive approach. There were no intraoperative or 30-day postoperative major complications. At 1 month postoperatively, the diabetic group achieved higher percentage of excess weight loss (EWL) (20.94 vs 17.93, p=0.014), however, at 3,6,9,12, and 18 months, the percentage of EWL were statistically comparable (Table 1). The diabetic group had a longer average length of stay compared with that of the non-diabetic group (2.98-2.63 days, p=0.09). In the diabetic group, one patient stayed for 13 days due to severe port site infection and another patient stayed for 9 days due to carpal tunnel syndrome exacerbation. No mortality occurred in this series.

Conclusions: BPD/DS for treatment of morbid obesity results in low morbidity and produces excellent outcomes. Preoperative diabetes mellitus does not predict inferior weight loss outcome after BPD/DS

Session: Poster Presentation

Program Number: P403

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