Biliopancreatic diversion with transient gastroplasty and duodenal switch: Long-term results of a multicentric study

Background. Over the years, several modifications of the Scopinaro biliopancreatic diversion (BPD) have been proposed. This retrospective study reported the results of 15 years of follow-up after open. BPD coupled with a type of transient gastroplasty (TG) and duodenal switch (DS), termed BPD-TG with DS. Methods. Data were analyzed for 874 patients operated on between January 1993 and May 2010 in 3 different surgical departments. Results. The median preoperative body mass index (BMI) was 52 kg/m(2) (range, 35-63). Comorbidities present were hypertension (57%), hypercholesterolemia (87%), hypertriglyceridemia (53%), type 2 diabetes (35%), and obstructive sleep apnea syndrome (OSAS; 9%). The mean follow-up was 11.9 3.1 years. The median BMI decreased to 33.9 after 1 year from bariatric surgery, 31.1 after 2-5 years, 30.9 after 5-10 years, and 31.2 kg/m2 after 10-15 years. Overall, 67% of diabetic patients were able to stop insulin and 97% were able to stop oral hypoglycemic drugs within 1 year Blood pressure, triglyceride levels, and cholesterol levels became normal in >96% of patients within I year. OSAS was resolved within 8 months in all cases. One year postoperatively, but absent thereafter we observed severe hypoalbuminemia (serum albumin <3 g/dL) in 1.7% of patients and severe iron-deficiency anemia in 1.9%. Incisional hernias were recorded in 30% and anastomotic ulcers in 2.4% of cases. Mortality was null. Conclusion. Our results suggest considering BPD-TG with DS as a viable bariatric operation, with its excellent long-term outcome in terms of weight loss, improvement of obesity-related diseases, and quality of life. (Surgery 2013;153:413-22.)