title: Revision of Biliopancreatic Diversion for Side Effects or Insufficient Weight Loss: Codification of a New Procedure.
abstract: Addressing the problem of proctologic sequelae after Scopinaro's classical BPD, we elongated the common limb from 50 to 200 cm at the expense of the alimentary limb and simultaneously, with the aim of avoiding weight regain, reduced the gastric pouch from 500 to 40 ml. After increased experience with the new procedure, we observed a favourable tendency towards further weight loss. Thus, we subsequently extended the indication to the procedure to patients with unsatisfactory weight loss after Scopinaro's classical BPD (SBPD).
  
  
  
  We retrospectively reviewed our clinical experience with the new procedure.
  
  
  
  From March 2008 to December 2014, 38 patients were submitted to the revisional procedure. The indication to surgical revision was proctologic in 26 patients and unsatisfactory weight loss in 12. After the revisional procedure, a significant reduction in bowel movements per day was observed, together with a significant reduction in body weight (from preoperative 87.1 ± 21 to 69.2 ± 13.5 kg at post-operative year 1 and 68.1 ± 11.9 kg at year 5; p < 0.001) and a parallel reduction in BMI (from preoperative 33.03 ± 7.6 to 26.8 ± 4.1 at post-operative year 1 and 26.9 ± 2.8 at year 5; p < 0.001). Mean excess BMI percent loss was 49.5 ± 94.6% at post-operative month 3, 76.51 ± 74.9% at year 1 and 76.2 ± 31.3% at year 5. Nutritional and metabolic parameters remained stable. Similar results were observed, analysing separately both groups of patients.
  
  
  
  Our preliminary data suggest that the proposed procedure could represent a safe and effective revisional tool to treat invalidating proctologic sequelae after SBPD, or when weight loss may be deemed unsatisfactory.
authors.affiliation: General Surgery, IRCCS Multimedica, Via Milanese 300, Sesto San Giovanni, 20099, Milan, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Ceriani
authors.affiliation: General Surgery, IRCCS Multimedica, Via Milanese 300, Sesto San Giovanni, 20099, Milan, Italy. ferdinando.pinna@tiscali.it.
authors.forename: Ferdinando
authors.identifier: 0000-0003-2596-3375
authors.initials: F
authors.lastname: Pinna
authors.affiliation: General Surgery, IRCCS Multimedica, Via Milanese 300, Sesto San Giovanni, 20099, Milan, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Lodi
authors.affiliation: Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.
authors.forename: Antonio E
authors.initials: AE
authors.lastname: Pontiroli
mesh_terms: D000328:Adult; D000368:Aged; D015904:Biliopancreatic Diversion / Q000009:adverse effects* / Q000379:methods; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000503:physiopathology / Q000601:surgery*; D011184:Postoperative Period; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D017211:Treatment Failure; D015431:Weight Loss
keywords: Biliopancreatic diversion; Distal gastric bypass; Malabsorption; Redo surgery; Weight regain