One-stage robotically assisted laparoscopic biliopancreatic diversion with duodenal switch: analysis of 179 patients.

Background: Biliopancreatic diversion with duodenal switch (BPD-DS) has been reported to be the most effective procedure for weight loss and minimizing postoperative weight regain. However, because of its technical complexity and concerns for higher operative and metabolic complications, it has not obtained widespread acceptance among patients or bariatric surgeons. Nevertheless, the use of robotic systems has been increasing because of its ability to overcome technical challenges, such as torque, freedom of movement, and precision. The objective of this study was to review the efficacy and safety of robotic assistance in laparoscopic BPD-DS.

Methods: A prospectively maintained database of patients who underwent robotic-assisted laparoscopic BPD-DS between 2008 and 2013 was reviewed retrospectively.

Results: A total of 179 consecutive patients (137 female and 42 male) were included in the study. The mean age was 44 years (20-72 yr). Mean body mass index (BMI) was 50.3 kg/m(2) (35-78.8 kg/m(2)), and the number of preoperative co-morbidities was 6.6 (2-14). Mean operative time for a typical BPD-DS with appendectomy was 249 minutes (162-413 min), which increased to 278 minutes (193-463 min) in adhesiolysis associated cases and increased to 272 minutes (186-431 min) if additional procedures, such as hiatal hernia repair, cholecystectomy, or Meckel's diverticulum resection, were included. All procedures were completed as a single-stage operation. There were no major intraoperative complications. Two patients had unexpected returns to the operating room during the same admission: one for an endoscopic release of an inadvertently sutured nasogastric tube and the other for port site infection. Median hospital stay was 2.7 days (1-13). Two patients had significantly longer stays for carpal tunnel syndrome exacerbation (9 d) and port site infection (13 d). Postoperatively, the median excess weight loss at 1, 3, 6, 9, 12, 18, 24, and 36 months with follow-up of 71% of patients at 1 year, 45% of patients at 2 years, and 15% of patients at 5 years, was 19%, 35.9%, 53.1%, 65.6%, 74.6%, 79.9%, and 75.8%, respectively. Diabetes, hypertension, and hyperlipidemia went into remission 95.5%, 92.1%, and 92% of the time, respectively. No mortality occurred.

Conclusions: Robotically assisted duodenoileal anastomosis during laparoscopic BPD-DS is a feasible, well-tolerated, and effective alternative to assist in the technically challenging part of the operation.