The Biliopancreatic Diversion with a Duodenal Switch (BPDDS): How Is It Optimally Performed?

The biliopancreatic diversion with duodenal switch can be performed by different combinations of restriction and malabsorption. The aim of this study was to evaluate weight loss and potential side effects for two variants of the procedure. All patients eligible for a 2-year follow-up (n = 182) was included in the study. Thirty-five patients (group A) had a gastric remnant with a volume of approximately 200 ml, an alimentary limb (AL) of 250 cm, and a common channel (CC) of 100 cm, while 147 patients (group B) had a gastric remnant of 100-120 ml, an AL of 40%, and a CC of 10% of the small bowel length. Preoperative variables, such as body mass index (BMI), sex, age, and factors that might influence weight loss, and postoperative weight loss and side effects were registered and compared. Preoperatively, the BMI was 50.6 in group A and 52.1 in group B (ns), with no difference in age, sex, or variables that might influence weight loss. At 2 years, the BMI was 33.1 in group A (n = 34) and 28.5 in group B (n = 119) with an adjusted difference in weight loss of 5.6 BMI units between the groups (p < 0.001). Vitamin D status was also better in group B than in group A at follow-up, while there was no difference in side effects. Patients with a remnant stomach of 100-120 ml, and AL and CC with individually adapted lengths had a larger weight loss and better vitamin D status postoperatively without an increase in side effects.