1st Division of General Surgery, Department of Medical & Surgical Sciences, University of Brescia, Brescia, Italy.
Obes Surg. 2011 Feb;21(2):139-45. doi: 10.1007/s11695-010-0333-6.
We aimed at comparing our long-term results after biliopancreatic diversion (BPD) with or without gastric preservation for morbid obesity. Between 1999 and 2009, we performed 540 BPD: 287 patients (group A) underwent BPD with distal gastric resection (BPD-AHS) and 253 (group B) underwent BPD associated with transitory vertical gastroplasty (TGR) with duodenal switch (DS). The results have been analyzed in terms of weight loss, improvement of comorbidities, and quality of life (Bariatric Analysis and Reporting Outcome System). The mean follow-up was 7.4 ± 2.9 years. One year after surgery, mean initial excess weight loss percentage was 69% for patients in group A (n = 287) and 65% for group B (n = 253); after 2-5 years, it was 74% for patients who underwent BPD-AHS (n = 130) and 75% for patients who underwent BPD-TGR-DS (n = 116); it was 71% and 74% for patients in group A (n = 157) and B (n = 137), respectively, followed up for >5 years (P = 0.27). Among the diabetic patients in both groups (191 patients), 64% discontinued the medication with insulin (P = 0.25), and 98% had stopped oral drugs within 1 year from surgery (P = 0.29). We did not observe deficiencies of vitamins and proteins. The overall incidence of incisional hernias was 38% (P = 0.35). We recorded 13 anastomotic ulcers (2.4%; P = 0.28). BPD represents, in spite of the side effects, an effective technique for treatment of morbid obesity and its associated diseases. Moreover, our results showed that patients who underwent BPD-TGR-DS had slightly better results in terms of postoperative metabolic complications and improvement in quality of life.
我们旨在比较我们在治疗病态肥胖时行保留胃的胆胰分流术（BPD）与不保留胃的 BPD 的长期结果。1999 年至 2009 年期间，我们共实施了 540 例 BPD：287 例患者（A 组）行 BPD 加远端胃切除术（BPD-AHS），253 例（B 组）行 BPD 联合暂时性垂直胃成形术（TGR）加十二指肠转位（DS）。我们根据体重减轻、合并症改善和生活质量（肥胖分析和报告结果系统）分析结果。平均随访时间为 7.4±2.9 年。术后 1 年，A 组（n=287）和 B 组（n=253）患者的初始超重体重减轻百分比分别为 69%和 65%；术后 2-5 年，行 BPD-AHS 的患者为 74%（n=130），行 BPD-TGR-DS 的患者为 75%（n=116）；A 组（n=157）和 B 组（n=137）分别随访超过 5 年的患者为 71%和 74%（P=0.27）。在两组糖尿病患者（191 例）中，64%的患者停用胰岛素（P=0.25），98%的患者在术后 1 年内停用口服药物（P=0.29）。我们未观察到维生素和蛋白质缺乏。切口疝总发生率为 38%（P=0.35）。我们记录了 13 例吻合口溃疡（2.4%；P=0.28）。尽管存在副作用，但 BPD 仍然是治疗病态肥胖及其相关疾病的有效方法。此外，我们的结果表明，行 BPD-TGR-DS 的患者在术后代谢并发症和生活质量改善方面的结果略好。
