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1.
Background: Biliopancreatic diversion (BPD) by Scopinaro's method is used by many as a surgical treatment for morbid obesity.
The authors present their results in 180 consecutive cases. Method: Between June 1995 and May 1998, the authors performed
BPD by Scopinaro's method on 180 patients (36 men) with morbid obesity, mean age 35.8 years (range 18-58 years), mean body
mass index (BMI) 48.8 kg/m2 (range 35-66 kg/m2). Results: In all cases, a gradual decrease in weight was obtained: the mean BMI at 1 month was 40.3 kg/m2, at 6 months 34 kg/m2, at 1 years 32 kg/m2, at 18 months 30.2 kg/m2, and at 36 months 28.8 kg/m2. At the same time a significant improvement in the pathologic conditions associated with morbid obesity was observed. Postoperative
complications were two duodenum blowout syndromes requiring prolonged intensive care, and an 18% rate of incisional hernias.
Conversion to normal small bowel continuity was necessary in three cases. Protein malnutrition developed in 2 patients (1.1%),
in 1 patient coinciding with addiction to cocaine. One patient could not psychologically accept the physical changes and requested
conversion. Anastomotic ulceration was seen in 11% of the patients. Operation for late obstruction occurred in 2 patients.
There was no mortality. Conclusions: Although BPD by Scopinaro's method is technically complex, it is safe and effective. 相似文献
2.
Giuseppe Noya MD Maria Laura Cossu MD Massimiliano Coppola MD GianCarlo Tonolo MD Maria Filippina Angius MD Enrico Fais MD Matteo Ruggiu MD 《Obesity surgery》1998,8(1):61-66
Background: Biliopancreatic diversion (BPD) by Scopinaro's method is an operation advocated by some surgeons as an effective
treatment for morbid obesity. Methods: Between February 1995 and April 1997 we performed BPD by Scopinaro's method on 50 patients
with morbid obesity (23 males), average age 41.4 years (range 20-63 years), average body weight 135.08 kg (range 89-256 kg),
mean body mass index (BMI) 50.65 kg/m2 (range 37.01-81.56 kg/m2). Results: In all cases a gradual decrease in weight was obtained [mean BMI at 1 month: 44.8 kg/m2, at 6 months (31 patients): 35.09 kg/m2, at 1 year (23 patients): 31.36 kg/m2, at 18 months (14 patients): 29.89 kg/m2 and at 2 years (5 patients): 29.27 kg/m2]. At the same time a significant improvement in the pathological conditions associated with morbid obesity was observed.
The patients were able to suspend oral antihypertensive and antidiabetic therapy as these parameters spontaneously returned
to normal values by the sixth postoperative month; all cases showed a marked reduction in hypercholesterolemia and hypertriglyceridemia.
Postoperative complications were: one death (2%) on the third day due to heart failure; two late intestinal occlusions (4%);
one acute dilatation of the stomach (2%); one peritonitis caused by early dehiscence of the anastomosis (2%); five anastomotic
ulcers (10%); two cases of protein malnutrition (4%). Conclusions: BPD by Scopinaro's method is a bariatric procedure which
is technically complex. However is it safe and reproducible and it induces a substantial weight loss. 相似文献
3.
Gaggiotti G Catassi C Sgattoni C Bonucci A Ricci S Spazzafumo L Coppa GV 《Obesity surgery》1995,5(4):424-426
Background: Biliopancreatic Diversion (BPD), excluding the jejunum and part of the ileum from the transit of the food, reduces
the absorptive intestinal area available to 250 cm of the distal ileum. The Intestinal Permeability Test (IPT) with Lactulose/Mannitol
is performed to assess the intestinal mucosa function. The aim of this study was to investigate the effect of intestinal anatomical
modifications induced by BPD on IPT in a group of severely obese patients. Methods: Group A: 18 severely obese subjects who
underwent BPD; the IPT was performed before (To) and 8.2 ± 0.9 days after BPD (T1). Group B: nine subjects of Group A; IPT was repeated 96.1 ± 12.7 days (T2) and 180.4 ± 19.7 days (T3) after BPD, respectively. IPT was expressed as the %Lactulose/%Mannitol ratio in the urine collected during 5 h after oral
administration (normal %L/%M < 0.04). Results: Data from Group A (paired Student's t-test) exhibited significantly higher values in T1 with respect to T0 for %L/%M (p < 0.05) and for %L (p < 0.05), and significantly lower values in T1 with respect to T0 (p < 0.001) for %M. In the Group B analysis of Variance from T0-T1-T2-T3 resulted statistically significant (p < 0.05) for %L/%M and %M. Conclusions: The reduction of intestinal absorption surface induced by BPD causes a significative
increase of the Lactulose/Mannitol IPT values, showing an intestinal mucosa function impairment. The IPT values improve progressively
at 3 and 6 months after this surgical procedure. 相似文献
4.
Scopinaro N 《Obesity surgery》1991,1(3):307-309
The author discusses why his operation of choice is biliopancreatic diversion (BPD). BPD is the most effective in obtaining
long-term weight loss and permits unchanged eating habits. Although BPD is technically demanding, revisions for protein malnutrition
or stomal ulcer have not been difficult and have become infrequent. However, lifelong follow-up must be guaranteed. 相似文献
5.
Luc L 《Obesity surgery》1993,3(2):179-180
During the past 7 years, 170 morbidly obese patients have been subjected to a biliopancreatic diversion. Mean weight loss
achieved over 2 years was greater than 70% of excess weight and was maintained. Early complications were rare. The most common
side-effects are discussed. The re-operation rate because of these side-effects was 7%. Eating normal meals, together with
a stable weight loss, has provided these patients with a better quality of life. 相似文献
6.
A 38-year-old female with a history of biliopancreatic diversion for morbid obesity developed a perforation at the distal
Roux-en-Y anastomosis 13 months after the original surgery. The etiology of this complication was not determined. Perforation
of a Roux-en-Y anastomosis occurring this late in the postoperative period has not been described previously. 相似文献
7.
Biliopancreatic Diversion with Transitory Gastroplasty Preserving Duodenal Bulb: 3 Years Experience 总被引:1,自引:1,他引:0
C Vassallo L Negri A Della Valle M Salvaneschi C Vegezzi A Griziotti C Dono P Mussi M G Bausardo P Pietrobono 《Obesity surgery》1997,7(1):30-33
Background: The authors have performed 521 bariatric surgery operations (319 restrictive procedures and 202 malabsorptive
procedures). Methods: During the last few years we have introduced an evolution of biliopancreatic diversion (BPD): BPD with
transitory gastroplasty, preserving the duodenal bulb (53 cases). From a technical point of view, the operation consists of
a BPD, coupled with a gastroplasty which is transitory due to the use of a polydioxanone (PDS) band. In the last few cases,
instead of a VBG (with PDS band) in order to make the operation completely reversible without any suture on the stomach, we
made a gastric pouch by banding with PDS calibrated with the same tube as for the Lap-band (20 cc). We maintained completely
the duodenal bulb (5 cm from the pylorus), making an end-to-side duodeno-ileal isoperistaltic anastomosis. Results: With this
anastomosis, only 2% of patients developed an anastomotic ulcer. With this new procedure, results have been good in terms
of weight loss (similar to that of BPD-AHS) and in nutritional complications. No patient has had hypoalbuminemia, diarrhea
or halitosis. Conclusion: BPD with temporary gastric restriction has provided satisfactory results. 相似文献
8.
Mutignani M Marchese M Tringali A Tacchino RM Matera D Foco M Greco F Costamagna G 《Obesity surgery》2007,17(2):251-254
Therapeutic biliary endoscopy after biliopancreatic diversion (BPD) for morbid obesity is not possible through the anatomical
route. In the case of a long excluded afferent limb, the possibility to reach endoscopically the papilla through a surgical
gastrostomy or jejunostomy has been reported. A case of laparoscopy-assisted ERCP performed 4 years after laparoscopic BPD
with distal gastrectomy, is reported. Access to the papilla was obtained laparoscopically by enterotomy, insertion of a trocar
into a jejunal loop 40 cm distal to the ligament of Treitz and passage of the duodenoscope through the trocar to the papilla.
A guidewire was laparoscopically advanced into the cystic duct, and bile duct cannulation was achieved using the rendez-vous
technique; endoscopic sphincterotomy and extraction of stones were successful. Laparoscopic cholecystectomy was performed
and the enterotomy was sutured. The clinical course was uneventful. 相似文献
9.
The experience and early complications in 66 morbidly obese patients who underwent biliopancreatic diversion are presented.
There was one death, due to a pulmonary embolus (PE) at home on the 15th postoperative day. Postoperative complications occurred
in nine patients, consisting of gastric hemorrhage (2), gastric outlet obstruction (2), non-lethal PE (1), deep vein thrombosis
(1), wound dehiscence (1), and asymptomatic gastric leak (1). In addition, there were 12 superficial wound infections. Four
patients required urgent reoperation for gastric hemorrhage (2), gastric outlet obstruction (1), and wound dehiscence (1).
The high complication rate is believed to represent the early part of the learning curve. Some reports of the early complications
following other bariatric operations are discussed. 相似文献
10.
BACKGROUND: Urgent late complications of biliopancreatic diversion (BPD) are rare and often require the experience of a bariatric surgery team for their immediate resolution. METHODS: The present work analyzes the incidence of emergency surgical conditions in a group of 138 patients who had undergone classical BPD, with a mean follow-up of 60 months (24-96) after BPD. RESULTS: Urgent surgical intervention was necessary in 9 patients out of 138 (6.5%): 7 (5%) were for intestinal obstruction (4 of the biliopancreatic limb and 3 of the alimentary tract); 2 (1.4%) were for stomal ulcer with complications (1 massive hemorrhage and 1 perforation). CONCLUSIONS:These complications of BPD are common to all GI operations, and thus are not specific to the type of surgery. We emphasize the importance of early diagnosis and treatment, particularly in regard to intestinal obstruction, because delay could have dramatic consequences. 相似文献
11.
Giuseppe Noya MD Maria Laura Cossu MD Massimiliano Coppola MD GianCarlo Tonolo MD Maria Filippina Angius MD Enrico Fais MD Matteo Ruggiu MD 《Obesity surgery》1998,8(1):67-72
Background: Besides weight loss Scopinaro's operation produces correction of hypercholesterolemia and noninsulin dependent
diabetes mellitus in all patients who suffer from these conditions. These results encouraged us to perform biliopancreatic
diversion (BPD) without gastric resection, thus preserving the functions of the stomach and pylorus in moderately overweight
patients with hypercholesterolemia associated with diabetes type II and hypertriglyceridemia. Methods: Between March 1996
and July 1997 we performed BPD without gastric resection on 10 moderately overweight patients [mean body mass index (BMI)
= 33.2 kg/m2]. All patients had suffered from hypercholesterolemia and hypertriglyceridemia for more than 5 years. Ten patients suffered
from diabetes type II; four of them had had insulin treatment or oral anti-diabetic agents; the other patients all had hyperglycaemia
in the fasted state and diabetes confirmed by preoperative oral glucose tolerance test (OGTT). Five patients suffered from
hypertension. Results: In all patients, cholesterol and triglyceride levels returned to normal within the first postoperative
month. Glycemia also stabilized at normal values in nine patients within the early weeks after surgery. One patient who took
70 U of insulin reduced his daily intake to 35 U 2 months postoperatively. In all patients blood pressure returned to normal.
Weight loss was predictably slight (10-15 kg). Conclusions: Our experience with the procedure found that this new method seems
to be as effective in controlling lipidic metabolism and diabetes II as the original version of BPD. As expected, weight loss
is only moderate, so that the modified BPD is not suitable for very obese patients. 相似文献
12.
López Deogracias M Domínguez-Diez A Palomar-Fontanet R González-Noriega M Rodrigo E Fernández-Fresnedo G Zubimendi JA Olmedo F Gómez-Fleitas M Arias M Fernández-Escalante C 《Obesity surgery》2007,17(4):553-555
Surgery is usually the only solution to modify the evolution of morbid obesity and resolve the associated co-morbidities.
There is very little written regarding malabsorptive surgery and transplantation. A 48-yearold male with hypertension, hyperuricemia
and obesity underwent renal transplantation in 1994 for renal amyloidosis. He was maintained on oral immunosuppressive cyclosporine.
The patient developed uncontrollable hypertension, hyperlipemia, hyperglycemia and increasing weight to a BMI of 44. Thus,
in December 2004, he underwent biliopancreatic diversion (BPD). After 18 months follow-up, he has lost 85% of his excess weight,
and his hypertension, hyperglycemia and hyperlipemia are markedly improved. Renal function was not modified, nor were the
levels of cyclosporine. He has had no complications derived from the BPD, and has a better quality of life. 相似文献
13.
Lagacé M Marceau P Marceau S Hould FS Potvin M Bourque RA Biron S 《Obesity surgery》1995,5(4):411-418
Background: In 1990, we modified Scopinaro's biliopancreatic diversion (BPD); instead of a distal gastrectomy and gastroileal
anastomosis, a parietal gastrectomy was performed with nutrients diverted through a duodenal switch. Also, the length of the
common channel (50 cm) was doubled to 100 cm, while the nutrient limb remained 250 cm. In 1991, we reported initial results
after 16 months: weight loss was as expected following BPD, but patients reported fewer side-effects and the prevalence of
excessive malabsorption was less. This cohort of patients had their duodenum stapled shut to construct the duodenal switch.
This staple-line failed insidiously in some patients, allowing the duodenum to recanalize partially or completely. This resulted
in an incomplete BPD. Methods: Since 1992, the duodenal switch has been constructed with a complete transection of the duodenum
to prevent recanalization. We report here on the first 61 patients who underwent this definitive procedure. Results: At 16
months, we observed a mean weight loss of 84% of initial excess weight, the number of daily stools at 2.9 ± 1.6 and the prevalence
of diarrhea at 10%. Twenty per cent of patients experienced mild anaemia, hypocalcemia, or hypoalbuminemia, which required
added supplements. Conclusions: BPD with parietal gastrectomy, duodenal switch and longer common channel improved weight loss
and decreased gastrointestinal side-effects without an increased prevalence of excessive malabsorption. The parietal gastrectomy
may contribute to weight loss by increasing satiety, and decreasing side-effects by regulating gastric emptying. 相似文献
14.
Biliopancreatic Diversion with a Duodenal Switch 总被引:12,自引:0,他引:12
Background: This paper evaluates biliopancreatic diversion combined with the duodenal switch, forming a hybrid procedure which
is a combination of restriction and malabsorption. Methods: The evaluation is of the first 440 patients undergoing this procedure
who had had no previous bariatric surgery. The mean starting weight was 183 kg, with 41% of our patients considered super
morbidly obese (BMI > 50). Results: There was an average maximum weight loss of 80% excess weight by 24 months postoperation;
this continued at a 70% level for 8 years. Major complications were found in almost 9% of the cases. There were two perioperative
deaths, one from pulmonary embolism and one from acute pulmonary obstruction. There were 36 type II diabetics, all of whom
have discontinued medication following the surgery. Seventeen revisions were performed to correct excess weight loss and low
protein levels. There have been no marginal ulcers, no cases of dumping syndrome, no foreign material used, and the procedure
is a pyloric saving procedure which is functionally reversible. Conclusions: This operation has vastly improved the lives
of seriously obese patients with many co-morbidities. All type II diabetics have essentially been cured of their disease.
The procedure was tolerated well and patients are quite satisfied. There was minimal regain of weight with this method. 相似文献
15.
Bariatric surgery is becoming an accepted method for weight reduction. Biliopancreatic diversion is reserved for high initial
BMI. With the increasing number of these procedures, the reports of complications become more important and prepare a wider
range of specialties to deal with them. We report a 62-year-old woman who developed a volvulus of the biliopancreatic loop
after a biliary diversion operation with a sleeve gastrectomy and antro-ileal anastomosis. Symptoms of biliopancreatic loop
obstruction are rather vague, presenting with atypical abdominal pain, nausea, sometimes vomiting, preserved bowel motility,
stool, and gas passage and normal upper GI X-ray. Due to the patient’s prompt reaction and straight referral to a bariatric
surgeon, freeing of the loop was enough to maintain its viability. The patient’s further recovery and follow-up were uneventful.
With this case, we stress the importance of an expert in such cases and a need to consider familiarizing doctors with these
patients and with the peculiarities of their treatment. 相似文献
16.
17.
Fox SR 《Obesity surgery》1991,1(1):89-93
The dilemma with which every bariatric surgeon is confronted is: What to do with the inevitable failures? In vertical gastric partitioning, revising the gastroplasty results in a high second failure rate. In an effort to improve the Success rate in failed gastroplasty patients who request revisionary surgery, the biliopancreatic bypass (classic Scopinaro procedure) was carried out on 57 patients. They have been followed for up to 10 years. The long-term weight loss has averaged 69.4 lb, which is 87% of the pregastroplasty excess weight. The price paid by these patients, in terms of complications, has been significant. Twenty-two Percent have developed hypoalbuminemia with its accompanying peripheral edema; 24% have required i.v. hyperalimintation because Of malnutrition. Sixteen percent of the patients developed a late post-op bowel obstruction, one resulting in death. Osteomalacia, spontaneous fractures have occurred. The biliopancreatic diversion procedure (BPD) is an effective weight-loss operation in the failed gastroplasty patients, but a significant price must be paid in terms of careful follow-up, nutritional deficiencies, and rehospitalizations. 相似文献
18.
Lozano O García-Díaz JD Cancer E Arribas I Rubio JL González-García I Galván M Alvarez J Martín-Duce A 《Obesity surgery》2007,17(5):642-648
Background Malabsorptive techniques to treat morbid obesity have been followed by alterations in phosphocalcic metabolism. Knowledge
of the preoperative situation is important to assess the influence of these techniques on phosphocalcic metabolism and to
consider treatments for these alterations.
Methods 61 consecutive morbidly obese patients (50 women, 11 men, age 19 to 63 years) having had biliopancreatic diversion (BPD) were
studied in a prospective manner. Preoperative and postoperative levels of calcium, phosphorus, 25-hydroxyvitamin D, tartrate
resistant acid phosphate, plasma parathormone (PTH), tubular absorption of phosphate, and urinary calcium and pyridinolines
were analyzed, as well as the potential risk factors for their alterations. Follow-up of all patients was a minimum of 4 years.
Results Before BPD, 42.3% of patients presented an increase in PTH and 54% a decrease in the 25-OH vitamin D, but the values of calcium
and plasma phosphorus maintained at normal level. 81.8% of the patients with an increase in the PTH maintained high levels
after BPD, while 60% of those with a normal preoperative PTH also presented hyperparathyroidism 4 years after the intervention.
A correlation between the levels of plasma PTH and body mass index was not found.
Conclusion Morbid obesity is accompanied by a high percentage of hyperparathyroidism. BPD produces malabsorption of vitamin D during
the first years, favoring the persistence or appearance of hyperparathyroidism. It is important to recognize and treat the
secondary hyperparathyroidism.The postoperative period could necessitate more energetic interventions to get more efficient
control of the phosphocalcic metabolism.
Work supported, in part, by a grant from Fondo de Investigaciones Sanitarias to the Red Temática de Investigación Cooperativa
G03/015. 相似文献
19.
The bowel-associated dermatosis-arthritis syndrome (BADAS), originally called the bowel bypass syndrome, and described after
jejuno-ileal bypass, has subsequently been reported in association with inflammatory bowel disease and after gastric resection.
BADAS has not been reported after biliopancreatic diversion (BPD). This case report describes a 47-year-old female who presented
with recurrent skin rashes and arthralgia after a BPD, consistent with a clinical diagnosis of BADAS which was confirmed by
skin biopsy. To date, she has been managed with cyclical courses of antibiotics without reversal of her surgery.This syndrome
may be under-diagnosed and is a condition with which bariatric surgeons should be familiar. 相似文献
20.
Background: Prader-Willi Syndrome (PrWS) is an uncommon neuroendocrine disorder of genetic origin, described in 1956 by Prader,
Labhart and Willi. The main clinical manifestations in the adult are mental retardation, hyperphagia with gross obesity, hypogonadismcriptorhismus
and short stature. The life expectancy of the affected individual ranges between 20 and 30 years - rarely beyond - due to
complications related to excessive obesity. Sustained dieting combined with behavior modification programs, as well as gastric
restrictive surgery for obesity, proved to have a high failure rate in PrWS, due to the patients' inability to cooperate in
changing their eating habits. Methods: Billiopancreatic Diversion (BPD), which does not require the patient's cooperation
in changing eating habits after surgery, was performed in two PrWS patients (13- and 22-years-old), both with excessive obesity,
severe respiratory distress, day sleepiness and limited mobility. Results: Two years after surgery, the 13-year-old had lost
80% of her overweight, while the 22-year-old, after 1 year, had lost 34%. Recent laboratory tests showed normal data in both
patients. Their respiratory distress had subsided completely, their mobility improved dramatically, and their self-image and
alertness enhanced. Conclusion: BPD resulted in an improved quality of life in these patients. 相似文献