Biliopancreatic diversion with duodenal switch for morbid obesity

Since February 2002, 71 patients have been operated on for morbidobesity according to the Marceau-Hess technique of biliopancreaticdiversion with duodenal switch (DS). Sixty women and 11 menaged 42.5 ± 10.9 had a body mass index (BMI) of 47.9 ± 7.0. Sixteenhad a prior bariatric surgery with gastric banding except verticalbanded gastroplasty in 1 case. Thirty eight patients presentedwith at least one comorbidity (type 2 diabetes, high blood pressure,sleep apnea). While the early experience with this operation wasdone exclusively by an open incision, the 47 most recent cases hada systematic laparoscopic approach. Of the 47 laparoscopic attempts20 were converted to open for: inadequate exposure (6),technical problems (3), severe adhesions (3), duodenal injury (3),bleeding (1). In 4 cases conversion to open was deliberate after partof the procedure was performed laparoscopically. For 3 patients theoperation was limited to a sleeve gastrectomy only due to ventilatoryproblems, inadequate exposure of the duodenum and cirrhosis,and 3 patients had a Scopinaro instead of a duodenal switch becauseof inadequate duodenal exposure after conversion to open with aBMI over 60. Overall the operating time for the biliopancreaticdiversions was 231 ± 53 minutes. The postoperative course wasuneventful in 61% of the cases. The most frequent complicationswere anastomotic leaks (12.8%), wound abcesses (11.4%) and postoperativebleeding (5.6%). Eight patients (11.2%) had early reoperation.One BMI 80 patient died at day 60 of acute renal failureafter gluteal rhabdomyolysis. During follow-up patients were reviewedat 1, 3 month postop. and then every 3 months during thefirst year, every 4 months during the second year and every 6 to 12months thereafter with regular blood sample, check up and vitaminsupplementation. Two patients died 9 months after the operation:one of peritonitis after the laparoscopic repair of a large ventralhernia and the other of a myocardial infarction that may be relatedto metabolic disorders in a patient more or less lost to follow up.Over time the BMI went down to 39.6 ± 5.4 3 months postop. to34.8 ± 17.3 at 1 year and 31.4 ± 5.7 at 2 years.