Partial and total biliopancreatic bypass in the surgical treatment of obesity

N. Scopinaro, E. Gianetta, D. Civalleri, U. Bonalumi, D. Friedman, V. Bachi

Research output: Contribution to journalArticlepeer-review

Abstract

One hundred and fourteen obese patients (93 females and 21 males) have been operated by biliopancreatic bypass (BPB), with a mean age, overweight and follow-up being 34 yr, 99 per cent and 25 months respectively. Three types of operation have been performed all entailing a distal gastrectomy with removal of the gallbladder: partial BPB (PBPB), in which the proximal half of the small bowel is anastomosed end-to-side to the distal ileum at 50 cm from the ileocecal valve, the distal half being anastomosed to the gastric stump (45 cases); total BPB type I (TBPB I), in which the proximal half of the small bowel is anastomosed end-to-end to the terminal 50 cm of the ileum, while the distal half is joined proximally to the gastric stump and distally to the side of the ascending colon (14 cases); total BPB type II (TBPB II), in which the small bowel is divided into three equal parts, with the proximal third anastomosed end-to-end to the distal one, and the middle third interposed between the gastric stump and the ascending colon (40 cases). Neither appetite decrease nor diarrhoea were generally observed. Mean excess weight per cent loss was: 64 ± 17 at 1 yr, 72 ± 17 at 2 yrs, 76 ± 20 at 3 yrs after PBPB; 63 ± 9 at 1 yr, 75 ± 12 at 2 yrs after TBPB 1; 81 ± 18 at 1 yr after TBPB II. Following all three types a sharp progressive liver improvement and a sustained reduction of serum cholesterol were demonstrated. The overall early complication rate was 8 per cent, including one death (0.9 per cent) from pulmonary embolism. Specific late complications were: anemia (30 per cent) and stomal ulcer (0 per cent in the first 28 operated patients, 23.1 per cent in the subsequent 39 patients and 3.7 per cent in the last 27 patients with a minimum follow-up of four months, depending on technical differences in gastrectomy and gastroenterostomy) after all three types. One patient with TBPB I (8 per cent) and ten with TBPB II (26 per cent) developed recurrent protein malnutrition; they are supported by oral or parenteral amino acid supplementation until they attain desired weight after which reoperation by a modified partial PBP can expect to normalize protein nutrition with weight maintenance. Partial BPB appears to be a safe and effective procedure. Further studies are needed for assessing the possible role of total BPB in obesity surgery.

Original languageEnglish
Pages (from-to)421-429
Number of pages9
JournalInternational Journal of Obesity
Volume5
Issue number4
Publication statusPublished - 1981

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Public Health, Environmental and Occupational Health
  • Endocrinology
  • Food Science
  • Endocrinology, Diabetes and Metabolism

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