Laparoscopic Versus Open Bilio-Pancreatic Diversion with Duodenal Switch: Comparable Weight Loss with Decreased Long Term Morbidity

E. James Hanowell, DO, Pradeep k Pallati, MD, Ananth Srinivasan, MD, Ranjan Sudan, MD FACS, Armour R Forse, MD FACS. Creighton UNiversity Medical Center, OMaha, Nebraska. Duke university, Durham, North Carolina

Objective: To compare long term outcomes between Laparoscopic and open Bilio-pancreatic Diversion with duodenal switch (BPD-DS) for treatment of morbid obesityBackground: The efficacy of Bilio-pancreatic diversion with duodenal switch as an effective primary procedure for treatment of morbid obesity is well established. BPD-DS is performed through laparoscopic approach with increasing technical expertise.Methods: Prospectively collected data from all patients who underwent BPD-DS at a single institution over a 10-year period beginning December 1999 was reviewed. Operative morbidity and mortality, weight loss and resolution of co-morbidities were recorded. statistical analysis was performed using a Fisher Exact test with a two-tailed p value for significanceResults: BPD-DS was performed by open approach on 87 patients and by laparoscopic approach on 64 patients. Both groups are well matched with regard to age (46 yrs and 45 yrs) and sex (80% and 83% female). Mean BMI of 52.2 kg/m² for the open group was statistically higher than the mean BMI of 45.5 kg/m² for the laparoscopic group. The number of pre-operative co-morbidites (including Hypertension, Type 2 Diabetes, Obstructive sleep apnea, Gastro-esophageal reflux disease, Degenerative joint disease, Depression and stress incontinence) were similar in both groups. The mean duration of follow-up was 3yrs for laparoscopic group and 5yrs and 8 months for Open group (median 2 and 6yrs). Excess weight loss (EWL) after 1 year was significantly higher in Laparoscopic group (71.6% Vs 63.7%) but this tapered of to insignificance over years. The resolution of co-morbidities at 1 year follow-up was similar in both groups except joint pain which was significantly higher in Laparoscopic group correlating with the EWL. Total number of complications were higher in open group compared to Laparoscopic group with significant predominace of ventral hernias in open group(50% Vs. 11%). There was no mortality.Conclusion: The Laparoscopic BPD-DS achieves similar bariatric results compared to open approach with significantly decreased long-term hernia complications. Open approach should be reserved for patients with hostile abdomen and every effort should be made to perform this procedure by laparoscopic approach.