Insufficient Weight Loss and Weight Regain After Bariatric Operation. Does Laparoscopic Biliopancreatic Diversion with Duodenal Switch Stand the Test of Time?

Iswanto Sucandy, MD, Andres Samayoa, MD, Fernando Bonanni, MD, FACS, Gintaras Antanavicius, MD, FACS. Abington Memorial Hospital, PA.

Introduction
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.

Methods
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).

Results
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.

Conclusions
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.

Keywords
Biliopancreatic diversion, Duodenal switch, Weight Loss, Weight Regain

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