Biliopancreatic diversion with duodenal switch in morbidly obese patients – long-term outcomes concerning the main comorbidities
DOI:
https://doi.org/10.5281/zenodo.14868916Keywords:
Biliopancreatic Diversion with Duodenal Switch, Morbid obesity, diabetes mellitus, hypertension, obstructive sleep apnea, arthropathyAbstract
INTRODUCTION: In the last two decades, the incidence of morbid obesity has increased worldwide. Surgical treatment has become a reliable treatment option that maintains excellent and stable weight loss results and control of the main comorbidities. The present study aims to evaluate and follow up the preoperative comorbidities: diabetes mellitus, hypertension, obstructive sleep apnea syndrome (OSA), dyslipidemia and arthropathy in patients with morbid obesity who were treated by the bariatric surgical technique "Biliopancreatic diversion with duodenal switch" (Biliopancreatic Diversion with Duodenal Switch).
MATERIALS AND METHODS: A combined retrospective and prospective study was performed on 141 morbidly obese patients who underwent Biliopancreatic Diversion with Duodenal Switch (BPD DP). The included cases were operated on and followed up between January 2003 and June 2013 at the University Hospital Center of Albacete, Spain. One hundred and twenty-eight patients underwent conventional operation with transverse supraumbilical laparotomy, and 13 patients – laparoscopic one. The cases included in the study were analyzed and followed up about the available concomitant diseases - diabetes mellitus, hypertension, obstructive sleep apnea syndrome (OSA), dyslipidemia and arthropathy – to evaluate their impact after the surgical intervention.
RESULTS: Diabetes mellitus resolved in 81.2% of patients, and arterial hypertension in 71.9%. Ninety-five percent of patients with COPD improved after the first year without needing CPAP, and this number remained stable in 6th year after surgery. Control of hypercholesterolemia and hypertriglyceridemia was established in 100% and 93.6% of patients, respectively. Poor results were reported regarding the accompanying arthropathy.
CONCLUSIONS: BPD DP is an effective bariatric surgical technique that leads to excellent results regarding main comorbidities such as diabetes mellitus, hypertension, COPD and dyslipidemia.
References
1. World Obesity Federation. Prevalence of obesity [Internet]. [cited 2022 Mar 12]. Available from: https://www.worldobesity.org/about/about-obesity/prevalence-of-obesity.
2. Doumouras AG, Lee Y, Babe G, Gmora S, Tarride JE, Hong D, et al. The hidden cost of an extensive preoperative work-up: predictors of attrition after referral for bariatric surgery in a universal healthcare system. Surg Endosc. 2020 Feb 1;34(2):988–95.
3. Moreno B, Zugasti A. Cirugía bariátrica: situación actual. Rev Med Univ Navarra. 2017 Oct 16;66–71.
4. Prasad M, Mark V, Ligon C, Dutia R, Nair N, Shah A, et al. Role of the Gut in the Temporal Changes of b-Cell Function After Gastric Bypass in Individuals With and Without Diabetes Remission. Diabetes Care. 2022 Feb 1;45(2):469–76.
5. Schauer PR, Ikramuddin S. Laparoscopic surgery for morbid obesity. Surg Clin North Am. 2001;81(5):1145–79.
6. Sjostrom L, Larsson B, Backman L, Bengtsson C, Bouchard C, Dahlgren S et al. Swedish obese subjects (SOS). Recruitment for an intervention study and a selected description of the obese state. Int J Obes Relat Metab Disord. 1992;16((6)):465-79.
7. Brian P. Jacob AP. Fischer JE. Mastery of Surgery, 5th Edition.editor: Lippincott Williams & Wilkins; 2007. 2383-401 p. p.
8. Gloy VL, Briel M, Bhatt DL, Kashyap SR, Schauer PR, Mingrone G, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and metaanalysis of randomized controlled trials. BMJ. 2013;347.
9. Buse JB, Caprio S, Cefalu WT, Ceriello A, Del Prato S, Inzucchi SE, et al. How do we define cure of diabetes? Diabetes Care. 2009 Nov;32(11):2133–5.
10. Våge V, Nilsen RM, Berstad A, Behme J, Sletteskog N, Gåsdal R, et al. Predictors for remission of major components of the metabolic syndrome after biliopancreatic diversion with duodenal switch (BPDDS). Obes Surg. 2013 Jan;23(1):80–6.
11. Peromaa-Haavisto P, Tuomilehto H, Kössi J, Virtanen J, Luostarinen M, Pihlajamäki J, et al. Prevalence of Obstructive Sleep Apnoea Among Patients Admitted for Bariatric Surgery. A Prospective Multicentre Trial. Obes Surg. 2016 Jul 1;26(7):1384–90.
12. Dwyer C, Mocanu V, Jogiat U, Birch DW, Karmali S, Switzer NJ. Obstructive Sleep Apnea Is Associated with Serious Complications But Not Increased Mortality Following Elective Bariatric Surgery: a Retrospective Cohort Study of 751,952 Patients. Obes Surg. 2022 Dec 1;32(12):4015–22.
13. Kaw R, Chung F, Pasupuleti V, Mehta J, Gay PC, Hernandez A V. Meta-analysis of the association between obstructive sleep apnoea and postoperative outcome. Br J Anaesth. 2012;109(6):897–906.
14. Baltasar A, Bou R, Bengochea M, Serra C, Pérez N. Mil operaciones bariátricas. Cir Esp. 2006 Jun 1;79(6):349–55.15.
15. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: A systematic review and meta-analysis. J Am Med Assoc. 2004 Oct 13;292(14):1724–37.
16. Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, et al. Weight and Type 2 Diabetes after Bariatric Surgery: Systematic Review and Meta- analysis. Am J Med. 2009 Mar;122(3).
17. Rubino F, Forgione A, Cummings DE, Vix M, Gnuli D, Mingrone G, et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg. 2006 Nov;244(5):741–9.
18. Roger Andersen J, Aasprang A, Bergsholm P, Sletteskog N, Våge V, Karin Natvig G. Health-related quality of life and paid work participation after duodenal switch. Obes Surg. 2010 Mar;20(3):340–5.
19. Andersen JR, Aasprang A, Bergsholm P, Sletteskog N, Våge V, Natvig GK. Predictors for health-related quality of life in patients accepted for bariatric surgery. Surg Obes Relat Dis. 2009 May;5(3):329–33.
20. Ahmed AR, Rickards G, Coniglio D, Xia Y, Johnson J, Boss T, et al. Laparoscopic Roux-en-Y Gastric Bypass and Its Early Effect on Blood Pressure. Obes Surg. 2009 Jul;19(7):845–9.
21. Rosmond R, Chagnon YC, Holm G, Chagnon M, Pérusse L, Lindell K, et al. Hypertension in Obesity and the Leptin Receptor Gene Locus 1 . J Clin Endocrinol Metab. 2000 Sep;85(9):3126–31.
22. Sjöström L, Lindroos A-K, Peltonen M, Torgerson J, Bouchard C, Carlsson B, et al. Lifestyle, Diabetes, and Cardiovascular Risk Factors 10 Years after Bariatric Surgery. N Engl J Med. 2004 Dec 23;351(26):2683–93.
23. Scopinaro N, Marinari GM, Camerini GB, Papadia FS, Adami GF. Specific effects of biliopancreatic diversion on the major components of metabolic syndrome: A long-term follow-up study. Diabetes Care. 2005 Oct;28(10):2406–11.
24. Våge V, Berstad A, Solhaug JH, Viste A. Cardiovascular risk factors in obese patients treated with jejunoileal bypass operation: A 25-year follow-up study. Scand J Gastroenterol. 2005 Jan;40(1):90–5.
25. Näslund E, Backman L, Holst JJ, Theodorsson E, Hellström PM. Importance of small bowel peptides for the improved glucose metabolism 20 years after jejunoileal bypass for obesity. Obes Surg. 1998;8(3):253–60.
26. Carter R, Watenpaugh DE. Obesity and obstructive sleep apnea: Or is it OSA and obesity? Pathophysiology. 2008 Aug;15(2):71–7.
27. Daigle CR, Brethauer SA. Obstructive sleep apnea in bariatric surgery patients. Minim Invasive Bariatr Surgery, Second Ed. 2015 Jan 1;485–90.
28. Kaw R, Chung F, Pasupuleti V, Mehta J, Gay P, Hernandez A. Obstructive Sleep Apnea and Postoperative Outcome. Chest. 2011 Oct;140(4):342A.
29. Dietrich A. Biliopancreatic Diversion with Duodenal Switch. Obes Metab Surg [Internet]. 2022 [cited 2023 Apr 5];131–8. Available from: https://link.springer.com/10.1007/978-3-662-63227-7_13
30. Sjöström L, Narbro K, Sjöström CD, Karason K, Larsson B, Wedel H, et al. Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects. N Engl J Med. 2007 Aug 23;357(8):741–52.
Downloads
Published
Issue
Section
License
Copyright (c) 2023 Toni Stoyanov (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
