Biliopancreatic diversion with duodenal switch for morbid obesity

Since February 2002, 71 patients have been operated on for morbid obesity according to the Marceau-Hess technique of biliopancreatic diversion with duodenal switch (DS). Sixty women and 11 men aged 42.5 +/- 10.9 had a body mass index (BMI) of 47.9 +/- 7.0. Sixteen had a prior bariatric surgery with gastric banding except vertical banded gastroplasty in 1 case. Thirty eight patients presented with at least one comorbidity (type 2 diabetes, high blood pressure, sleep apnea). While the early experience with this operation was done exclusively by an open incision, the 47 most recent cases had a systematic laparoscopic approach. Of the 47 laparoscopic attempts 20 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 part of the procedure was performed laparoscopically. For 3 patients the operation was limited to a sleeve gastrectomy only due to ventilatory problems, inadequate exposure of the duodenum and cirrhosis, and 3 patients had a Scopinaro instead of a duodenal switch because of inadequate duodenal exposure after conversion to open with a BMI over 60. Overall the operating time for the biliopancreatic diversions was 231 +/- 53 minutes. The postoperative course was uneventful in 61% of the cases. The most frequent complications were anastomotic leaks (12.8%), wound abcesses (11.4%) and postoperative bleeding (5.6%). Eight patients (11.2%) had early reoperation. One BMI 80 patient died at day 60 of acute renal failure after gluteal rhabdomyolysis. During follow-up patients were reviewed at 1, 3 month postop. and then every 3 months during the first year, every 4 months during the second year and every 6 to 12 months thereafter with regular blood sample, check up and vitamin supplementation. Two patients died 9 months after the operation: one of peritonitis after the laparoscopic repair of a large ventral hernia and the other of a myocardial infarction that may be related to 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. to 34.8 +/- 17.3 at 1 year and 31.4 +/- 5.7 at 2 years.