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Long-term results of biliopancreatic diversion in the treatment of morbid obesity

Langzeitergebnisse mit der biliopankreatischen Umleitung zur Behandlung der morbiden Adipositas

  • Main Topics: Morbid Obesity — New Therapeutic Concepts
  • Published:
Acta chirurgica Austriaca Aims and scope Submit manuscript

Summary

Background: The continuing evolution and the mechanisms of actions of biliopancreatic diversion (BPD) as malabsorptive approach to the surgical treatment of obesity are evaluated.

Methods: In a series of 2273 patients operated on during the last 21 years, BPD was progressively modified in order to adapt the operation to the individual patients’ characteristics.

Results: There was a mean permanent reduction of about 75% of the initial excess weight. The other beneficial effects, besides those consequent to weight loss and/or reduced nutrient absorption, included permanent normalization of serum glucose and cholesterol without any medication and on totally free diet in 100% of cases, both phenomena being due to a specific action of the operation. Operative mortality was less than 0.5%. Specific late complications included: anemia, less than 5% with adequate iron and/or folate supplementations; stomal ulcer, reduced to 3.0% by oral H2-blockers prophylaxis; bone demineralization, increasing up to the fourth year and tending to decrease thereafter, with need of calcium and vitamin D supplementation; neurological complications, totally avoidable by prompt vitamin B administration to patients at risk; protein malnutrition, which was reduced to a minimum of 2.8% with 1.2% recurrence, in exchange with a smaller weight loss, by adapting the volume of the gastric remnant and the length of the alimentary limb to the patient’s individual characteristics.

Conclusions: The correct use of BPD, based on the knowledge of its mechanisms of action, can make the procedure a very effective and safe one in all hands.

Zusammenfassung

Grundlagen: Die kontinuierliche Entwicklung und der Aktionsmechanismus der biliopankreatischen Umleitung als Malabsorptionsmethode in der chirurgischen Behandlung der Adipositas werden erforscht.

Methodik: In einer Serie von 2273 Patienten, die in einem Zeitraum von 21 Jahren operiert wurden, ist die Methode zunehmend modifiziert und den individuellen Gegebenheiten der Patienten angepaßt worden.

Ergebnisse: Eine durchschnittliche permanente Reduktion des initialen Überschußgewichtes von 45% wurde erzielt, einhergehend mit einer Normalisierung von Cholesterin und Blutzucker. Die operative Mortalität lag unter 0,5%. Spezifische Spätkomplikationen sind: Anämie (5%), Anastomosenulkus (3%), Knochendemineralisation und Eiweißmangel.

Schlußfolgerungen: Die korrekte Anwendung der biliopankreatischen Umleitungsoperation, basierend auf dem Wissen und dem Aktionsmechanismus, kann den Eingriff zu einer sicheren und wirkungsvollen Methode in der Behandlung der morbiden Adipositas machen.

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Authors and Affiliations

  1. From the Department of Surgery, University of Genoa School of Medicine, Genoa, Italy

    N. Scopinaro M.D., G. F. Adami, G. M. Marinari, E. Traverso, G. Camerini, G. Baschieri & A. Simonelli

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  1. N. Scopinaro M.D.
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  2. G. F. Adami
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  3. G. M. Marinari
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  4. E. Traverso
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  5. G. Camerini
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  6. G. Baschieri
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  7. A. Simonelli
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Correspondence to N. Scopinaro M.D..

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Scopinaro, N., Adami, G.F., Marinari, G.M. et al. Long-term results of biliopancreatic diversion in the treatment of morbid obesity. Acta Chir Austriaca 30, 166–171 (1998). https://doi.org/10.1007/BF02620442

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  • DOI: https://doi.org/10.1007/BF02620442

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