title: Biliopancreatic diversion with transient gastroplasty and duodenal switch: long-term results of a multicentric study.
abstract: BACKGROUND
  Over the years, several modifications of the Scopinaro biliopancreatic diversion (BPD) have been proposed. This retrospective study reported the results of 15 years of follow-up after open BPD coupled with a type of transient gastroplasty (TG) and duodenal switch (DS), termed BPD-TG with DS.
  
  
  METHODS
  Data were analyzed for 874 patients operated on between January 1993 and May 2010 in 3 different surgical departments.
  
  
  RESULTS
  The median preoperative body mass index (BMI) was 52 kg/m² (range, 35-63). Comorbidities present were hypertension (57%), hypercholesterolemia (87%), hypertriglyceridemia (53%), type 2 diabetes (35%), and obstructive sleep apnea syndrome (OSAS; 9%). The mean follow-up was 11.9 ± 3.1 years. The median BMI decreased to 33.9 after 1 year from bariatric surgery, 31.1 after 2-5 years, 30.9 after 5-10 years, and 31.2 kg/m² after 10-15 years. Overall, 67% of diabetic patients were able to stop insulin and 97% were able to stop oral hypoglycemic drugs within 1 year. Blood pressure, triglyceride levels, and cholesterol levels became normal in >96% of patients within 1 year. OSAS was resolved within 8 months in all cases. One year postoperatively, but absent thereafter, we observed severe hypoalbuminemia (serum albumin <3 g/dL) in 1.7% of patients and severe iron-deficiency anemia in 1.9%. Incisional hernias were recorded in 30% and anastomotic ulcers in 2.4% of cases. Mortality was null.
  
  
  CONCLUSIONS
  Our results suggest considering BPD-TG with DS as a viable bariatric operation, with its excellent long-term outcome in terms of weight loss, improvement of obesity-related diseases, and quality of life.
authors.affiliation: Department of Medical & Surgical Sciences, 1st Division of General Surgery, University of Brescia, Brescia Civic Hospital, Italy. giacomopata@alice.it
authors.forename: Giacomo
authors.initials: G
authors.lastname: Pata
authors.forename: Nicola
authors.initials: N
authors.lastname: Crea
authors.forename: Ernesto
authors.initials: E
authors.lastname: Di Betta
authors.forename: Ottavio
authors.initials: O
authors.lastname: Bruni
authors.forename: Carlo
authors.initials: C
authors.lastname: Vassallo
authors.forename: Francesco
authors.initials: F
authors.lastname: Mittempergher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018798:Anemia, Iron-Deficiency / Q000209:etiology; D050110:Bariatric Surgery / Q000009:adverse effects / Q000379:methods*; D015904:Biliopancreatic Diversion / Q000009:adverse effects / Q000379:methods*; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000378:metabolism / Q000601:surgery; D004386:Duodenum / Q000601:surgery*; D005260:Female; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D034141:Hypoalbuminemia / Q000209:etiology; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007558:Italy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents