The bilio-intestinal bypass.
BACKGROUND
Since 1990 we adopted the bilio-intestinal bypass (BIBP) for all morbid obese patients eligible to a malabsorption procedure. Since 2001 we used laparoscopic technique.


METHODS
102 patients; mean age 35.4 (18-54) years; preoperative mean weight Kg 148.3 (105-225); mean preoperative BMI 54.1 kg/m2 (40-66.2); mean follow-up 10 years (1-22). 83 patients underwent open and 19 laparoscopic BIBP. The operation was performed with five lap ports. Section of the jejunum 30 cm from the Treitz and of mesentery was made by linear stapler. The cholecysto-jejunal anastomosis was completed with 45 mm linear stapler. A side-to-side anastomosis between the proximal jejunum and the last 12-18 cm of the ileum was created by firing a 60 mm linear stapler. On the excluded ileum an anti-reflux valve system was hand-sutured.


RESULTS
Five years post-operatively mean weight was 89 (62-130) kg, mean BMI was 31 (24-41) kg/m2. Two patients of the 19 laparoscopic patients were converted in open surgery for adhesions post-appendectomy. The main late complications were incisional hernia (19.3%) and abdominal bloating (2.9%). The reversal and conversion rate was 65%. There was no death.


CONCLUSIONS
Our experience showed that five years post-BIBP the weight loss was satisfactory in 90.7% of patients. Using laparoscopic technique it is possible to reduce pain, in-hospital time, respiratory and thromboembolic complications, convalescence and incisional hernia.
Micheletto
Giancarlo
G
Dipartimento di Scienze Chirurgiche, Cattedra di Chirurgia Generale della'Università degli Studi di Milano, Istituto Clinico S. Ambrogio, Milano. giancarlo.micheletto@unimi.it
Mozzi
Enrico
E
Lattuada
Ezio
E
Lanni
Marco
M
Perrini
Massimo
M
Caccialanza
Riccardo
R
Spinola
Alessandra
A
Santamaria
Matteo
M
Sala
Barbara
B
Doldi
Santo Bressani
SB
D000293:Adolescent; D000328:Adult; D001662:Biliary Tract Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D015992:Body Mass Index; D005500:Follow-Up Studies; D006801:Humans; D007581:Jejunoileal Bypass / Q000295:instrumentation / Q000379:methods*; D010535:Laparoscopy / Q000379:methods; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011788:Quality of Life; D012189:Retrospective Studies; D013528:Surgical Staplers; D016896:Treatment Outcome; D015431:Weight Loss