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Is laparoscopic single-stage biliopancreatic diversion with duodenal switch safe in super morbidly obese patients?
Masoud Rezvani1, Iswanto Sucandy1, Amarita Klar1
1Department of Surgery, Institute for Bariatric and Metabolic Surgery, Abington Memorial Hospital, Abington, Pennsylvania.
Background:
It has been hypothesized that the morbidity and mortality of laparoscopic biliopancreatic diversion with duodenal switch (BPD-DS) are likely to increase with increasing body mass index (BMI), especially with BMI>50 kg/m(2). Therefore, a 2-stage approach to this procedure has been advocated in super morbidly obese patients. The authors hypothesized that a BMI ≥ 50 kg/m(2) does not significantly influence the morbidity and mortality perioperatively associated with this procedure.
Methods:
A retrospective analysis of all patients who underwent laparoscopic BPD-DS between January 2009 and September 2011 was performed. The patients were divided into 2 groups: patients with BMI<50 kg/m(2) and those with BMI>50 kg/m(2). Patient characteristics, perioperative variables, 30-day outcomes, and complications were analyzed and compared.
Results:
A total of 226 patients underwent laparoscopic BPD-DS. Mean patient age was 44.9 years (range: 20-72 yr). Male to female ratio was 59 to 170 patients (75% versus 25%), respectively. Mean BMI was 50.2 kg/m(2) (range: 37.2-68.8 kg/m(2)). A total of 127 patients had a BMI<50 kg/m(2) (Group 1), and 99 patients had a BMI ≥ 50 kg/m(2) (Group 2). The length of procedure in Groups 1 and 2 was 296 minutes and 287 minutes, respectively (P = .25). The rate of conversion to open BPD-DS was 1.5% in Group 1 and 3% in Group 2 (P = .65). Two leaks occurred in Group 1; no patient in Group 2 developed this complication. One patient in Group 2 developed pulmonary embolism. The rates of all other complications resulting in a longer length of stay were 11% in Group 1 and 8% in Group 2 (P = .50). The 30-day reoperation rate was 3% in Group 1 and 1% in Group 2 (P = .39). The mean length of stay was 3.97 days for Group 1 and 3.67 days for Group 2 (P = .34). No mortality occurred in this series.
Conclusion:
In the present study, BMI ≥ 50 kg/m(2) did not increase intraoperative or postoperative complications at 30 days after laparoscopic PBD-DS. No significant differences were noted between patients with BMI ≥ 50 kg/m(2) and patients with BMI<50 kg/m(2). A single-stage laparoscopic BPD-DS procedure can be safely offered to the super morbidly obese patients.
