Laparoscopic biliopancreatic diversion with distal gastric preservation: technique and three-year followup.
BACKGROUND
Biliopancreatic diversion (BPD) has been used satisfactorily as one of several surgical treatments against morbid obesity in order to achieve long-term weight reduction. Our goal was to develop the BPD laparoscopically in humans in order to improve postoperative recovery and to reduce early and late complications, above all those derived from the abdominal wall, while maintaining the weight reduction results achieved. In addition, in order to reduce the laparoscopic difficulty of BPD technique and some complications associated with gastrectomy, we only carried it out in cases in which we considered it indispensable.


METHODS
Since October 2000 we have performed 50 laparoscopic BPD with distal gastric preservation (39 women and 11 men). We preserve the distal stomach if the upper digestive endoscopy with biopsy does not show pathological findings.


RESULTS
Two operations (within the first ten cases) were converted to open surgery. The average operating time was 177.7 minutes (range, 110-360 minutes). There were no immediate postoperative complications. There was no postoperative mortality.


CONCLUSIONS
It has been proven that BPD can be performed satisfactorily using laparoscopy, but this technique requires a very skilled and experienced laparoscopic surgeon. Avoiding gastrectomy is a very interesting option in order to reduce technical difficulties, surgeon stress, duration of the operation, patient stress, and, probably, postoperative morbidity and mortality. Laparoscopic BPD with distal gastric preservation is a very promising bariatric procedure with potential advantages over laparoscopic BPD with gastrectomy or open BPD.
Resa
J Joaquín
JJ
Unidad de Cirugía, Hospital Royo Villanova, Zaragoza, Spain. jjresa@aragob.es
Solano
Jorge
J
Fatás
J Antonio
JA
Blas
J Luis
JL
Monzón
Andrés
A
García
Alejandro
A
Lagos
Javier
J
Escartin
Jorge
J
D000328:Adult; D015904:Biliopancreatic Diversion / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D015431:Weight Loss