Safety of biliopancreatic diversion with duodenal switch in patients with body mass index less than 50 kg/m 2

Introduction Biliopancreatic diversion with duodenal switch (BPD-DS) has often been reserved for patients with BMI > 50 kg/m 2 . We aim to assess the safety of BPD-DS in patients with morbid obesity (BMI 3 35 kg/m 2 and < 50 kg/m 2 ) using a 150-cm common channel (CC), 150-cm Roux limb, and 60-fr bougie. Methods A retrospective review was performed on patients with a BMI < 50 mg/k 2 who underwent a BPD-DS in 2016–2019 at a single institution. Limb lengths were measured with a laparoscopic instrument with minimal tension. Sleeve gastrectomy was created with 60-fr bougie. Variables were compared using paired t test, Chi-square analysis or repeated measures ANOVA where appropriate. Results Forty-five patients underwent BPD-DS. CC lengths and Roux limb lengths were 158 ± 20 cm and 154 ± 18 cm, respectively. Preoperative BMI was 44.9 ± 2.3 kg/m 2 and follow-up was 2.7 ± 1.4 years. One patient required reoperation for bleeding and died from multiorgan failure and delayed sleeve leak. There was 1 (2.2%) readmission for contained anastomotic leak and 2 ED visits (4.5%) within 30 days. There were no marginal ulcers, limb length revisions, or need for parental nutrition. Percent excess weight loss was 67.2 ± 19.7%. 88.9% ( N = 8), 86.6% ( N = 13), and 55.5% ( N = 5) of patients had resolution or improvement of their diabetes mellitus type II, hypertension, and hyperlipidemia, respectively. 40% ( N = 4) of patients had resolution of their gastroesophageal reflux disease (GERD) and 11.4% ( N = 5) developed de novo GERD. 32% ( N = 14) of patients had vitamin D deficiency and 25% ( N = 11) experienced zinc deficiency. Conclusion BPD-DS may be considered in patients with BMI < 50 kg/m 2 with 150-cm CC, 150-cm Roux limb, and a 60-fr bougie sleeve gastrectomy. There was sustained weight loss and no protein calorie malnutrition, but Vitamin D and zinc deficiency remained a challenge. Careful patient selection and proper counseling of the risks and benefits are necessary. Graphical abstract