title: [Advances in bariatric surgery: from the open approach to the biliopancreatic bypass with laparoscopic gastric preservation. Twelve years of experience].
abstract: BACKGROUND
  An analysis is presented of the results in the treatment of morbid obesity after 12 years experience.
  
  
  METHODS
  A retrospective study of patients subjected to surgery for morbid obesity from July 1998 to April 2010. Open techniques were initially used, and from January 2005 using biliopancreatic bypass with gastric diversion by a laparoscopic approach.
  
  
  RESULTS
  A total of 165 patients have been subjected to surgery, 65 with open surgery (gastric bypass and Scopinaro), and 100 laparoscopic. The mean age was 40 years, with 74% females. The mean BMI was 48.6±6 kg/m(2), with 35% super-obese. The mean hospital stay was 7 days, with a morbidity of 26% (43 patients). Seven patients required further surgery, and 2 patients died. There was 99.4% follow-up during a median period of 46 months (1 to 141). There were complications of the gastro-jejunostomy in 17 patients. Seven patients required further surgery due to transmesenteric hernias. The rate of overweight lost was 67% (95% CI: 65-72%), 68% (95% CI: 65-72%) and 68% (95% CI: 63-73%) at 12, 36 and 60 months, respectively. The rate of excess BMI lost was 73% (95% CI: 70-76%), 74% (95% CI: 70-79%) and 74% (95% CI: 68-69%) at 12, 36 and 60 months, respectively. Comparing both approaches, there were more post-operative complications, longer hospital stays, and more incisional hernias in the open approach, with no significant differences found in the rest of the parameters analysed.
  
  
  CONCLUSIONS
  Our long-term results are within those classified as excellent, with acceptable morbidity and mortality. A great advance has been observed in the laparoscopic approach due to the less aggressive surgery, and maintaining an excellent weight loss.
authors: Complejo Asistencial Universitario de Burgos, Burgos, España. frajasama@telefonica.net
authors: Francisco Javier
authors: FJ
authors: Sánchez Manuel
authors: Salvador
authors: S
authors: Rodríguez Serrano
authors: María
authors: M
authors: de la Plaza Galindo
authors: Alberto
authors: A
authors: Palomo Luquero
authors: Juan Luis
authors: JL
authors: Seco Gil
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects / Q000379:methods*; D015904:Biliopancreatic Diversion / Q000009:adverse effects / Q000379:methods*; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors