Gracia Jose-Antonio, Martinez Mariano, Aguilella Vicente, Elia Manuela, Royo Pablo
Department of Surgery, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
Obes Surg. 2007 Oct;17(10):1306-11. doi: 10.1007/s11695-007-9233-9.
Laparoscopic gastric bypass, currently the most popular surgical method for bariatric therapy, have proved to be effective in weight loss, but some matters regarding its long-term efficacy for super-obese patients (BMI >50 kg/m2) have arisen. Biliopancreatic diversion (BPD) is a complex technique that has shown good results in the treatment of the super-obese patient. We analyze our >5 years results, evaluating weight loss, morbidity and mortality of this operation, depending on the length of the common and alimentary limbs.
We studied two series of patients: 150 patients with BPD of Scopinaro (50-200 cm) and 70 patients with modified BPD (75-225 cm). The results have been analyzed in terms of weight loss, co-morbidity improvement, and postoperative morbidity using BAROS.
Range of follow-up is 1-12 years. Weight loss was slightly higher for the Scopinaro group than for the Modified group but with no significant difference. There was more prevalence of malnutrition and of iron deficiency in the Scopinaro group (16% and 60%) than in the modified group (2% and 40%), with similar postoperative morbidities.
The modified BPD method (75-225 cm) shows long-term effectiveness in weight loss and comorbidity improvement for super-obesity. Proteins, vitamins and oligoelement deficits appear distant in time, and thus it is necessary to maintain strict followup of these patients and supplement against deficiencies for the rest of their lives.
腹腔镜胃旁路手术是目前最流行的减肥治疗手术方法，已被证明在减肥方面有效，但对于超级肥胖患者（BMI>50kg/m²）的长期疗效出现了一些问题。胆胰分流术（BPD）是一种复杂的技术，在治疗超级肥胖患者方面已显示出良好效果。我们分析了超过5年的结果，根据共同支和消化道支的长度评估该手术的体重减轻、发病率和死亡率。
我们研究了两组患者：150例接受Scopinaro BPD手术（50 - 200cm）的患者和70例接受改良BPD手术（75 - 225cm）的患者。使用BAROS对体重减轻情况、合并症改善情况和术后发病率进行了分析。
随访时间为1 - 12年。Scopinaro组的体重减轻略高于改良组，但无显著差异。Scopinaro组的营养不良和缺铁患病率（分别为16%和60%）高于改良组（分别为2%和40%），术后发病率相似。
改良BPD方法（75 - 225cm）在治疗超级肥胖方面显示出长期的减肥和改善合并症效果。蛋白质、维生素和微量元素缺乏在术后较晚时间出现，因此有必要对这些患者进行严格的长期随访，并终生补充缺乏的物质。
