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Background: It is hypothesized that the morbidity and mortality of laproscopic bilio-pancreatic diversion with duodenal switch (LBPD/DS) are likely to increase with increasing body mass index (BMI), especially when > 50 kg/m(2). Some authors, therefore, advocate a two-stage approach to this procedure in the super-morbidly obese. We hypothesize that a BMI≥50 kg/m(2) does not significantly influence peri-operative morbidity with this procedure.
Methods: A prospective database of all patients who underwent laproscopic/robotic bilio-pancreatic diversion with duodenal switch between January 2009 and September 2011 was analyzed. Two groups were identified: those with BMI <50 kg/m(2) (Group 1) and those with BMI≥50 kg/m(2) (Group 2). Patient demographics, length of procedure (LOP), intra-operative complications, conversion to open rates and postoperative outcomes, including 30-day complication rate, rate of re-operation at 30 days, rate of other interventions, length of stay (LOS) and readmission were compared. T-test and Fischer’s exact test were used where appropriate. P-values <0.05 were considered significant.
Results: 226 patients underwent (LBPD/DS). Mean patient age was 44.9 years (range: 20-72). 170 (75%) of patients were female. Mean BMI was 50.2 kg/m(2) (range: 37.2-68.8). 127 had BMI <50 kg/m(2) (Group 1), and 99 had a BMI≥50 kg/m(2) (Group 2). The LOP in Group 1 was 296 minutes and 287 minutes in Group 2 (p=0.25). The rate of conversion to open was 3% in Group 2 and 1.5% in Group 1 (p=0.65).
There were no mortalities. Only one intra-operative complication occurred in Group 1; none in Group 2. The rate of stenosis requiring endoscopic intervention was 0.7% in Group 1 and 1% in Group 2 (p=1.0). Two leaks occurred in Group 1; no patient in Group 2 developed these complications. One patient in Group 2 developed pulmonary embolism. The rates of all other complications resulting in a longer LOS were 11% in Group 1 and 8% in Group 2 (p=0.50).
The 30-day re-operation rate was 3% in Group 1 and 1% in Group 2 (p=0.39). The rate of re-intervention (endoscopic or percutaneous) was 1.57% in Group 1 and 1% in Group 2 (p=1.0). The mean LOS was 3.97 days for Group 1 and 3.67 for Group 2 (p=0.34). The 30-day readmission rate was 11% in Group 1 and 10% in Group 2 (p=1.00).
Conclusion: BMI≥50 kg/m(2) does not increase intraoperative or postoperative complications at 30 days in ( LBPD/DS ). No significant differences were noted between the 2 groups in any of the outcomes. A single-stage procedure can be safely offered to patients with BMI≥50 kg/m(2).