Laparoscopic adjustable pyloric band with fundoplication in bariatric surgery: technique and preliminary results.
BACKGROUND
Laparoscopic biliopancreatic diversion according to Scopinaro is an extremely effective operation for weight loss, but carries significant morbidity in terms of metabolic deficiencies.


METHODS
A study was conducted as to the feasibility, safety and efficiency of a novel procedure, accomplishing a 'reversible Scopinaro BPD', performed in two stages: first the placement of an adjustable band in a juxtapyloric position, aiming at maintaining postprandial satiety, and second, the construction of a transmesocolic Roux-en-Y gastro-enterostomy with a 2.5-m long distal jejunal limb, reanastomosed 50 cm proximal to the ileocecal valve.


RESULTS
15 patients, mean BMI 38.9, 8 males and 7 females, underwent the first stage of pyloric adjustable banding. All benefited at the same time from a Nissen fundoplication, to avoid gastroesophageal reflux. 1 patient was withdrawn from the study at this stage because of peritonitis of unknown cause and removal of the band. 3 patients benefited from the second stage of the operation because of insufficient weight loss, and/or symptoms of gastric stasis. 1 patient developed diarrhea and was treated by peroral cholestyramine. Weight loss was similar to the regular BPD figures.


CONCLUSIONS
The placement of an adjustable gastric band in a juxtapyloric position, combined with a Nissen fundoplication, appears to be a safe and efficient satiety-inducing operation. In case of insufficient weight loss, and/or exaggerated gastric stasis, a Scopinaro BPD construction can be added to the otherwise unharmed stomach, hereby constituting an instantly reversible malabsorptive component.
Himpens
Jacques
J
Department of Gastrointestinal and Obesity Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium. jacques_himpens@hotmail.com
D000328:Adult; D000465:Algorithms; D050110:Bariatric Surgery / Q000379:methods*; D015904:Biliopancreatic Diversion / Q000379:methods*; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000517:prevention & control; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D016896:Treatment Outcome