Micheletto Giancarlo, Mozzi Enrico, Lattuada Ezio, Lanni Marco, Perrini Massimo, Caccialanza Riccardo, Spinola Alessandra, Santamaria Matteo, Sala Barbara, Doldi Santo Bressani
Dipartimento di Scienze Chirurgiche, Cattedra di Chirurgia Generale della'Università degli Studi di Milano, Istituto Clinico S. Ambrogio, Milano.
Ann Ital Chir. 2007 Jan-Feb;78(1):27-30.
Since 1990 we adopted the bilio-intestinal bypass (BIBP) for all morbid obese patients eligible to a malabsorption procedure. Since 2001 we used laparoscopic technique.
102 patients; mean age 35.4 (18-54) years; preoperative mean weight Kg 148.3 (105-225); mean preoperative BMI 54.1 kg/m2 (40-66.2); mean follow-up 10 years (1-22). 83 patients underwent open and 19 laparoscopic BIBP. The operation was performed with five lap ports. Section of the jejunum 30 cm from the Treitz and of mesentery was made by linear stapler. The cholecysto-jejunal anastomosis was completed with 45 mm linear stapler. A side-to-side anastomosis between the proximal jejunum and the last 12-18 cm of the ileum was created by firing a 60 mm linear stapler. On the excluded ileum an anti-reflux valve system was hand-sutured.
Five years post-operatively mean weight was 89 (62-130) kg, mean BMI was 31 (24-41) kg/m2. Two patients of the 19 laparoscopic patients were converted in open surgery for adhesions post-appendectomy. The main late complications were incisional hernia (19.3%) and abdominal bloating (2.9%). The reversal and conversion rate was 65%. There was no death.
Our experience showed that five years post-BIBP the weight loss was satisfactory in 90.7% of patients. Using laparoscopic technique it is possible to reduce pain, in-hospital time, respiratory and thromboembolic complications, convalescence and incisional hernia.
自1990年起，我们对所有适合进行吸收不良手术的病态肥胖患者采用胆肠旁路术（BIBP）。自2001年起，我们采用腹腔镜技术。
102例患者；平均年龄35.4（18 - 54）岁；术前平均体重148.3（105 - 225）千克；术前平均体重指数54.1千克/平方米（40 - 66.2）；平均随访10年（1 - 22年）。83例患者接受开放手术，19例接受腹腔镜BIBP手术。手术通过五个腹腔镜端口进行。使用线性缝合器在距屈氏韧带30厘米处切断空肠及其系膜。用45毫米线性缝合器完成胆囊空肠吻合术。使用60毫米线性缝合器在近端空肠和回肠末段12 - 18厘米之间进行侧侧吻合。在旷置的回肠上手工缝合一个抗反流瓣膜系统。
术后五年平均体重为89（62 - 130）千克，平均体重指数为31（24 - 41）千克/平方米。19例腹腔镜手术患者中有2例因阑尾切除术后粘连转为开放手术。主要的晚期并发症为切口疝（19.3%）和腹胀（2.9%）。逆转和转换率为65%。无死亡病例。
我们的经验表明，BIBP术后五年，90.7%的患者体重减轻情况令人满意。使用腹腔镜技术可以减轻疼痛、缩短住院时间、减少呼吸和血栓栓塞并发症、促进康复并降低切口疝的发生率。
