[Surgical technique and outcome in metabolic and bariatric surgery: biliopancreatic diversion]

The aim of the study was to investigate surgical results and outcome using biliopancreatic diversion (BPD) and duodenal switch (BPD-DS) as a representative profile for Germany.

From January 2005 to December 2007, overall 163 patients had undergone BPD (n = 72) and BPD-DS (n = 91) including 21 "redo" operations who were registered in the nation-wide multicentre (n = 48) observational -study for quality assurance of surgical treatment in morbid obesity. BPD and BPD-DS were performed in 5 of the 48 participating German surgical departments. A laparoscopic approach with no conversion was possible in 96.7 % of BPD and 50.6 % of BPD-DS, respectively.

Body weight (mean BMI, 53.6 kg / m(2)) was considerably reduced down to a mean BMI of 36.7 kg / m(2) (BPD) and 33.2 kg/m(2) (BPD-DS). The operating time in average was 134 min in BPD and 234 min in BPD-DS, respectively. Postoperative hospital stay was as follows: BPD, 8 d; BPD-DS, 15 d. The rate of general postoperative complications (pneumonia, urinary infection) was 17.6 % whereas the specific complication rate (disturbances of wound healing) was only 12.1 % (mortality, 0). Relaparotomy was required in 5 patients (post-operative bleeding, n = 3; anastomotic insufficiency, n = 2). In 50 % of the repeat cases, a laparoscopic -approach was initially favoured followed by conversion. Follow-up investigation revealed trocar hernia, n = 2 (within 1 year); abdominal hernia, n = 1 (within 6 months).

The surgical results obtained with BPD and, in particular, with BPD-DS represent data similar to those of a learning curve. Occurrence, type and rate of the reported complications are comparable with international data from the literature. The ongoing benchmarking project indicates the efforts for a continuous control and improvement of the quality in this type of surgical treatment.