title: [Prevalence of anal diseases after Scopinaro's biliopancreatic bypass for super-obese patients].
abstract: BACKGROUND
  Biliopancreatic diversion by Scopinaro (BD) is a mixed (malabsortive and restrictive) bariatric technique that is successful in achieving long lasting weight lost in super obese patients. In fact, the diarrhoea (steatorrhea) that is expected after any malabsortive technique can sometimes cause significant nutritional changes and anal disease: these patients are frequently referred to our coloproctology outpatient clinic due to haemorrhoids, fissures, anal sepsis and fistula basically due to changes in quality and quantity of their faeces. The aim of this paper is to find out not only the prevalence of anal disease in our series of super obese surgical patients but also to compare the incidence between the two surgical techniques we perform in our department.
  
  
  METHODS
  We analyzed 263 consecutive patients operated on BD of Scopinaro (50-200 cm) and modified-BD (75-225 cm) in our Department. Patients who had previously suffered from anal surgery were excluded.
  
  
  RESULTS
  There were 45 patients (18%) who suffered from anal problems of which 38 cases (84.4%) were BD-S and only 7 cases with BD-M complained of anal disorders (p < 0.05). Overall, at the 18th month review, the mean number of motions per day was 3.5 (range, 1-15). Patients with BD-S had 5 motions per day as a mean. The mean number of motions for BD-M was 2. The frequency order of anal pathology observed was: anal fissure, haemorrhoids, abscess and fistula.
  
  
  CONCLUSIONS
  Higher incidence of anal pathology after BD of Scopinaro is another factor to take into account to avoid performing classic Scopinaro BD as opposed to modified BD for the treatment of morbid super obesity. It is mandatory to be conservative when facing anal problems in these patients, and firstly we must modify eating habits and the nutritional status. Surgery must be highly respectful to anal sphincters to avoid incontinence.
authors.affiliation: Servicio de Cirugía General B, Hospital Clínico Universitario, Zaragoza, España.
authors.forename: Manuela
authors.initials: M
authors.lastname: Elía Guedea
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Gracia Solanas
authors.forename: Pablo
authors.initials: P
authors.lastname: Royo Dachary
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Ramírez Rodríguez
authors.forename: Vicente
authors.initials: V
authors.lastname: Aguilella Diago
authors.forename: Mariano
authors.initials: M
authors.lastname: Martínez Díez
mesh_terms: D000328:Adult; D015904:Biliopancreatic Diversion / Q000706:statistics & numerical data*; D003108:Colonic Diseases / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology* / Q000601:surgery*; D011184:Postoperative Period; D015995:Prevalence