Is laparoscopic single-stage biliopancreatic diversion with duodenal switch safe in super morbidly obese patients?

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/m². Therefore, a 2-stage approach to this procedure has been advocated in super morbidly obese patients. The authors hypothesized that a BMI50 kg/m² 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/m² and those with BMI>50 kg/m². 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/m² (range: 37.2-68.8 kg/m ²). A total of 127 patients had a BMI<50 kg/m² (Group 1), and 99 patients had a BMI50 kg/m² (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, BMI50 kg/m² did not increase intraoperative or postoperative complications at 30 days after laparoscopic PBD-DS. No significant differences were noted between patients with BMI50 kg/m² and patients with BMI<50 kg/m². A single-stage laparoscopic BPD-DS procedure can be safely offered to the super morbidly obese patients.