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A Clinical and Nutritional Comparison of Biliopancreatic Diversion With and Without Duodenal Switch

Dolan, Kevin FRCS; Hatzifotis, Michael MBBS; Newbury, Leyanne BSc; Lowe, Nadine MBBS; Fielding, George FRACS

doi: 10.1097/01.sla.0000129280.68540.76
Original Articles
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Objective: To compare biliopancreatic diversion (BPD) without duodenal switch (DS) and with duodenal switch (BPDDS).

Background: A reduction of 70% of excess body weight can be achieved after BPD, but there is a risk of malnutrition and diarrhea. This risk may be reduced by pyloric preservation with BPDDS.

Methods: BPD was performed until 1999, when BPDDS was introduced, both with a common channel of 50 cm. At their latest clinic visit, patients filled in a questionnaire regarding weight loss, dietary history, gastrointestinal symptoms, obesity-related comorbidity, and medication including dietary supplements and underwent a serum nutritional screen.

Results: BPD was performed in 73 patients and BPDDS in 61 patients, with a median preoperative body mass index (BMI) of 44.8 kg/m2 and a median follow-up of 28 months. There were no significant differences between BPD and BPDDS with regards to age, sex, BMI, or morbidity. Median excess weight loss and BMI at 12, 24, and 36 months was 64.1, 71.0, and 72.1% and 33.1, 31.5, and 31.5 kg/m2, respectively; there were no significant differences between BPD and BPDDS. There were no significant differences between BPD and BPDDS with regards to meal size, fat score, nausea, vomiting, diarrhea, or nutritional parameters. However, 18% of patients were hypoalbuminemic, 32% anemic, 25% hypocalcemic, and almost half had low vitamin A, D, and K levels, despite more than 80% taking vitamin supplementation.

Conclusion: DS does not improve weight loss or lessen the gastrointestinal or nutritional side effects of BPD.

Biliopancreatic diversion (BPD) was performed in 73 patients without duodenal switch (DS) and 61 patients with duodenal switch (BPDDS). Excess weight loss was 70% after BPD and BPDDS, and there were no significant differences in gastrointestinal symptoms, meal size, or nutritional parameters. Duodenal switch does not improve weight loss or lessen the gastrointestinal or nutritional side effects of BPD.

From the Department Of Surgery, Royal Brisbane Hospital, Queensland, Australia.

Reprints: Kevin Dolan, FRCS, Joondalup Health Services, Suite 109, Shenton Avenue, Joondalup, WA 6027, Australia. E-mail: medkd@iprimus.com.au.

© 2004 Lippincott Williams & Wilkins, Inc.