Should biliopancreatic diversion with duodenal switch be done as single-stage procedure in patients with BMI ≥50 kg/m2?

Single-stage BPD-DS in the super obese appears to be a relatively safe procedure with a low rate of conversion when a laparoscopic approach is used. Although from the published data, the morbidity and mortality are increased for super obese patients, especially men, the BMI itself cannot be considered a contraindication for single-stage BPD-DS, because other factors such as surgical experience also influence the outcome. Despite these variables, performing a sleeve gastrectomy first should be considered for heavier, male, and at-risk patients.