Early results of laparoscopic biliopancreatic diversion with duodenal switch: A case series of 40 consecutive patients

被引:381
作者
Ren, CJ [1 ]
Patterson, E [1 ]
Gagner, M [1 ]
机构
[1] Mt Sinai Med Ctr, Dept Surg, Div Laparoscop Surg, New York, NY 10029 USA
关键词
laparoscopic surgery; laparoscopy; biliopancreatic diversion; duodenal switch; morbid obesity; super obesity; bariatric surgery;
D O I
10.1381/096089200321593715
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: Biliopancreatic diversion with duodenal switch (BPD-DS) is an operation which provides one of the greatest maintained weight losses of any bariatric procedure. We looked at the safety and efficacy of laparoscopic BPD-DS for morbid obesity. Methods: A 150-200 mi sleeve gastrectomy was created and anastomosed to the distal 250 cm of divided ileum. The median length of the common channel was 100 cm. All patients were prospectively followed up to 12 months. Results: 40 consecutive patients underwent laparoscopic BPD-DS as a primary procedure for morbid obesity. Median patient body mass index (BMI) was 60 kg/m(2) (range 42-85 kg/m(2)). Mean age was 43 +/- 1 years (+/- SEM), with 12 males and 28 females. One patient was converted to open laparotomy (2.5%). Median operative time was 210 +/- 9 minutes (range 110-360 minutes) with a significant correlation between BMI and operative time (p = 0.04). Median length of stay was 4 days (range 3 - 210 days). There was one 30-day mortality(2.5%). Major morbidities occurred in 6 patients (15%), including 1 anastomotic leak (2.5%), 1 venous thrombosis (2.5%), 4 staple-line hemorrhages (10%) and 1 subphrenic abscess (2.5%). Median follow-up at 6 months (range 1-12 months) resulted in 46% +/- 2% excess weight loss (EWL) and at 9 months 58% +/- 3% EWL. Conclusion: Laparoscopic BPD-DS is a complex, yet feasible, procedure resulting in effective weight loss with an acceptable morbidity. A BMI >65 was associated with increased morbidity and mortality. A long-term study is needed to confirm efficacy and proper patient selection.
引用
收藏
页码:514 / 523
页数:10
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