Salame Marita, Teixeira Andre F, Lind Romulo, Abi Mosleh Kamal, Ghanem Muhammad, Jawad Muhammad A, Kendrick Michael L, Ghanem Omar M
Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA.
Department of Surgery, Orlando Health, Orlando, FL, 32806, USA.
Obes Surg. 2025 Jan;35(1):93-101. doi: 10.1007/s11695-024-07640-4. Epub 2024 Dec 19.
The effectiveness of biliopancreatic diversion with duodenal switch (BPD/DS) for weight loss is well established, yet there remains ongoing debate over optimal limb lengths to maximize weight loss without compromising safety. We aimed to evaluate the impact of BPD/DS limb lengths on weight loss outcomes and comorbidity resolution.
A multicenter review of patients who underwent primary BPD/DS between 2008 and 2022. Patient demographics, common channel (CC) length, Roux limb (RL) length, and weight loss outcomes at 6, 12, and 24 months were collected. Postoperative complications and comorbidity resolution were reported.
A total of 720 patients (60 with 100-cm CC/150-cm RL length, 596 with 125-cm CC/125-cm RL length, 64 with 150-cm CC/150-cm RL length) were included with a mean follow-up of 21 ± 19 months. The %TWL at 24 months was higher in the 100/150 (44.1 ± 10.3%) and 125/125 (40.6 ± 10.6%) groups compared to the 150/150 group (35.9 ± 10.8%) (p < 0.001). After adjusting for age, preoperative BMI, gender, and diabetes status, CC length was independently associated with %TWL, showing a 1.8% decrease at 24 months for every 10-cm increase in CC length (p < 0.001). The 100/150 group had higher remission rates for T2DM (p = 0.007), OSA (p < 0.001), and HTN (p = 0.036) but also higher late complications (28.5% vs. 12.5%, 7%, p < 0.001). No significant early complications were observed (p = 0.149).
A shorter CC length of 100 cm is associated with greater weight loss and comorbidity resolution in BPD/DS patients up to 2 years after the surgery. Careful consideration of long-term risks is needed to minimize a higher prevalence of late complications. Further studies are necessary for sustained long-term weight loss outcomes.
胆胰转流十二指肠转位术（BPD/DS）在减重方面的有效性已得到充分证实，但对于在不影响安全性的前提下实现最大程度减重的最佳肠袢长度仍存在持续争论。我们旨在评估BPD/DS肠袢长度对减重效果和合并症缓解的影响。
对2008年至2022年间接受初次BPD/DS手术的患者进行多中心回顾性研究。收集患者的人口统计学数据、共同通道（CC）长度、Roux肠袢（RL）长度以及术后6、12和24个月时的减重效果。报告术后并发症及合并症缓解情况。
共纳入720例患者（60例CC长度为100 cm/RL长度为150 cm，596例CC长度为125 cm/RL长度为125 cm，64例CC长度为150 cm/RL长度为150 cm），平均随访时间为21±19个月。与150/150组（35.9±10.8%）相比，100/150组（44.1±10.3%）和125/125组（40.6±10.6%）在24个月时的%TWL更高（p<0.001）。在调整年龄、术前BMI、性别和糖尿病状态后，CC长度与%TWL独立相关，CC长度每增加10 cm，24个月时的%TWL下降1.8%（p<0.001）。100/150组的2型糖尿病（p=0.007）、阻塞性睡眠呼吸暂停（OSA，p<0.001）和高血压（HTN，p=0.036）缓解率更高，但晚期并发症也更多（28.5%对12.5%、7%，p<0.001）。未观察到显著的早期并发症（p=0.149）。
在BPD/DS患者术后长达2年的时间里，100 cm的较短CC长度与更大程度的体重减轻和合并症缓解相关。需要仔细考虑长期风险，以尽量减少晚期并发症的较高发生率。对于持续的长期减重效果，还需要进一步研究。
