Background

Super obesity (BMI ³ 50) is a complex medical condition often requiring more aggressive surgical options to achieve significant lasting weight loss. Biliopancreatic diversion with duodenal switch (BPD/DS) leads to greater weight loss but is less commonly performed compared to the Roux-en-Y gastric bypass (RYGB), in part due to perceived increased complication rates. This study aimed to analyze perioperative complications in patients with SO undergoing BPD/DS and RYGB procedures.

Methods

Patient data for years 2015 through 2019 of the MBSAQIP database were used. BPD/DS and RYGB procedures were compared using nearest neighbor 1:1 propensity score matching (PSM) with a 0.2 caliper width to create a balanced matched cohort.

Results

Patients receiving either the BPD/DS or RYGB procedure numbered 2,977 and 37,973 respectively. Patients having the BPD/DS procedure were more likely to be of Hispanic ethnicity (13.5% vs 11.5%;p=0.001), require a mobility device (4.5% vs 2.9%;p<0.001), have a smoking history (10.7% vs 9.0%;p=0.003), and higher BMI (58.4 vs 56.6; p<0.001). After matching, most complications did not differ significantly: intervention (2.2% vs 1.9%;p=0.497), readmission (6.4% vs 5.6%;p=0.306), reoperation (2.9% vs 2.0%;p=0.061) or death (0.3% vs 0.2%;p=0.547). Patients undergoing the BPD/DS experienced higher rates of postoperative organ space infection (0.9% vs 0.3%;p=0.004), sepsis (0.6% vs 0.2%;p=0.022), and postoperative leak (1.6% vs 0.6%;p=0.001).

Conclusions

Patients with SO undergoing the BPD/DS procedure are higher risk for infectious complications but the BPD/DS procedure has shown to be as safe as the RYGB for most complications in the short-term for these higher risk patients.