Background

Biliopancreatic diversion with duodenal switch (BPD-DS) remains a cornerstone of malabsorptive procedures with the highest expected postoperative excess body weight loss which is often offered to patients with a BMI above 50 and less likely to those below. Thus, we intended to study patients with a BMI less than 50 who have undergone BPD-DS and their long-term outcomes.

Methods

Review of institutional database to identify patients with a preoperative BMI less than 50 who underwent primary minimally invasive BPD-DS between January 2012 and December 2017. Exclusion criteria included revisional surgery or staged or aborted surgery. %excess weight loss (%EWL) was recorded at every postoperative visit at different time intervals as per our institutional follow up schedule for these patients.

Results

163 consecutive patients, 64% females, mean age of 46 and preoperative BMI 45. Most frequent common channel length was 125 cm (53%) with mean as 122 cm. Mean length of stay was 1.73 days. Seven patients (4%) had 30-day postoperative complications, 3 of which were surgical site infections, 1 bile leak, 1 UTI, 1 new onset atrial fibrillation and 1 DVT. Mean %EWL was 8% at 1 week, 19% at 1 month, 36% at 3 months, 71% at 1 year, 64% at 5 years and 61% at 10 years (31 pts). Six patients required parenteral nutrition at any point in time postoperatively.

Conclusions

The study describes the feasibility of BPD-DS with an adjusted or longer common channel as a valid and safe surgical option for BMI less than 50.