Studies Comparing BPD and BPD-DS
Studies comparing BPD and BPD-DS that show how the BPD-DS
procedure performed today has better results with fewer
complications.
Obesity surgery results depending on technique performed:
long-term outcome.
Gracia et al. April 2009
BACKGROUND: Many techniques have excellent results at 2
years of follow-up but some matters regarding their long-term
efficacy have arisen. This is why bariatric surgery results
must be analyzed in long-term follow-up. The aim of this
study was to extend the analysis over 5 years, evaluating
weight loss, morbidity, and mortality of the surgical
procedures performed.
METHODS: This was a retrospective cohort study of the different
procedures for morbid obesity practiced in our Department of
Surgery for morbid obesity. The results have been analyzed in
terms of weight loss, morbidity improvement, and postoperative
morbidity (Bariatric Analysis And Reporting Outcome System).
RESULTS: One hundred twenty-five patients were operated on
open vertical banded gastroplasty (VBG), 150 patients of open
biliopancreatic diversion (BPD) of Scopinaro, 100 patients
of open modified BPD (common limb 75 cm; alimentary limb 225
cm), and 115 patients of laparoscopic Roux-en-Y gastric bypass
(LRYGBP). Mean follow-up was: VBG 12 years, BPD 7 years, and
LRYGBP 4 years. An excellent initial weight loss was observed
at the end of the second year of follow-up in all techniques,
but from this time an important regain of weight was observed
in VBG group and a discrete weight regain in LRYGBP group.
Only BPD groups kept excellent weight results so far in time.
Mortality was: VBG 1.6%, BPD 1.2%, and LRYGBP 0%. Early
postoperative complications were: VBG 25%, BPD 20.4%, and
LRYGBP 20%. Late postoperative morbidity was: protein malnutrition
11% in Scopinaro BPD, 3% in Modified BPD group, and no cases
reported either in VBG group or LRYGBP group; iron deficiency
20% VBG, 62% Scopinaro BPD, 40% modified BPD, and 30.5% LRYGBP.
A 14.5% of VBG group required revision surgery to gastric bypass
or to BPD due to 100% weight regain or vomiting. A 3.2% of
Scopinaro BPD with severe protein malnutrition required revision
surgery to lengthen common limb to 100 cm. A 0.8% of LRYGBP
required revision surgery to distal LRYGBP (common limb 75 cm)
due to 100% weight regain.
CONCLUSIONS: The most complex bariatric procedures increase
the effectiveness but unfortunately they also increase morbidity
and mortality. LRYGBP is safe and effective for the treatment
of morbid obesity. Modified BPD (75-225 cm) can be considered
for the treatment of superobesity (body mass index > 50 kg/m(2)),
and restrictive procedures such as VBG should only be performed
in well-selected patients due to high rates of failure in long-term
follow-up.
Duodenal Switch Improved Standard Biliopancreatic Diversion:
A Retrospective Study.
Marceau at al. Jan-Feb 2009
BACKGROUND: This was a retrospective study, performed 10
years after surgery, to compare the results between biliopancreatic
diversion (BPD) with distal gastrectomy (DG) versus BPD with
duodenal switch (DS).
METHODS: Complete follow-up data were available for 96% of
patients, allowing a comparison of weight loss, revision,
side effects, and complications at 10 years.
RESULTS: After BPD-DS, weight loss was 25% greater than after
BPD-DG (46.8 +/- 21.7 kg versus 37.5 +/- 22 kg, respectively;
P <.0001). The need for revision decreased from 18.5% to 2.7%
(P <.0001), and the prevalence of vomiting during the previous
month was 50% less (23.7-50.6%, P <.0001) after BPD-DS compared
with after BPD-DG. Late complications were the same for both
procedures. Blood analysis showed that, after BPD-DS, the
levels of calcium, iron, and hemoglobin were significantly
greater and the parathyroid hormone level was lower than
after BPD-DG (71.3 +/- 44.2 versus 103.0 +/- 64.0 ng/L,
respectively; P <.0001).
CONCLUSION: The DS greatly improved the BPD, as it was initially
proposed. The use of the DS increased weight loss, decreased
the need for revision, resulted in fewer side effects, and
improved the absorption of nutrients.
Biliopancreatic Diversion with Duodenal Switch.
Marceau et al. Sept 1998
In 1990 Scopinaro’s technique of biliopancreatic diversion
with distal gastrectomy (DG) and gastroileostomy was modified.
A sleeve gastrectomy with duodenal switch (DS) was used
instead of the distal gastrectomy; and the length of the
common channel was made 100 cm instead of 50 cm. A questionnaire
and a prescription for blood work were sent to 252 patients
who underwent DG a mean 8.3 years ago (range 6-13 years) and
465 patients who underwent DS 4.1 years ago (range 1.7-6.0
years). The questionnaire response rate was 93%, and laboratory
work was completed for 65% of both groups. The mean weight
loss after DG was 37 +/- 21 kg and after DS 46 +/- 20 kg.
There were fewer side effects after DS: The number of daily
stools was lower (p < 0.0002), as was the prevalence of diarrhea
(p < 0.01), vomiting (p < 0.001), and bone pain (p < 0.001).
Greater benefits related to several aspects of life were reported
after DS than DG (p < 0.0001). The mean serum levels of ferritin,
calcium, and vitamin A were higher (p < 0.001), and parathyroid
hormone was lower. The yearly revision rate for excessive
malabsorption was 1.7% per year after DG and 0.1% per year
after DS. The two procedures were equally efficient for treating
co-morbid conditions such as diabetes, hypertension, and
hypercholesterolemia. Biliopancreatic diversion with sleeve
gastrectomy/duodenal switch and a 100-cm common limb was shown
to produce greater weight loss with fewer side effects.
Biliopancreatic Diversion with a New Type of Gastrectomy.
Marceau et al. Feb 1993
In an attempt to improve the results of biliopancreatic
diversion in the treatment of morbid obesity, two aspects
of the procedure performed at Laval Hospital were modified
to reduce adverse physiological consequences. The distal
gastrectomy was replaced by a parietal gastrectomy which
preserves vagal continuity along with the lesser curvature,
and leaves intact the antro-pyloroduodenal pump. The duodenum
was stapled shut and nutrients were diverted through a duodeno-ileal
anastomosis. The biliopancreatic diverting intestinal limb was
anastomosed to the nutrient ileal limb 100 cm proximal to the
ileocaecal valve instead of 50 cm proximal to it, thus doubling
the length of the common ileal absorptive segment. Weight loss
after either operation was greater than 70% of initial excess
weight. Following the new operation, there was a lesser prevalence
of side-effects, especially loose stools and malodorous gas, a
lesser degree of hypocalcemia and no hypoalbuminemia. The duodenum
recanalized at the staple line in 20% of the patients who had the
new operation. When data from these patients were excluded, weight
loss following the new operation was greater than that seen after
the old one. The prevalence of side-effects and the degree of
calcium and protein malabsorption remained significantly lower.
Weight loss remained satisfactory with a common limb measuring
100 cm. The parietal gastrectomy was not restrictive as shown by
the failure to lose further weight when the duodenal stapled
diversion failed. Weight loss was thus mainly a function of
biliopancreatic diversion, but increased weight loss in the new
procedure despite a doubling of the common ileal limb suggests
that parietal gastrectomy contributed to weight loss. Because
duodenal recanalization can be corrected surgically and now
prevented, the modified biliopancreatic bypass is preferred.