Ceriani Valerio, Pinna Ferdinando, Lodi Tiziana, Pontiroli Antonio E
General Surgery, IRCCS Multimedica, Via Milanese 300, Sesto San Giovanni, 20099, Milan, Italy.
Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.
Obes Surg. 2017 Apr;27(4):1091-1097. doi: 10.1007/s11695-017-2575-z.
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.
为解决斯科皮纳罗经典胆胰分流术（BPD）后的直肠病后遗症问题，我们将共同肠袢从50厘米延长至200厘米，代价是牺牲营养肠袢，同时，为避免体重反弹，将胃囊从500毫升减至40毫升。随着对新手术经验的增加，我们观察到体重进一步减轻的有利趋势。因此，我们随后将该手术的适应症扩大到斯科皮纳罗经典BPD（SBPD）后体重减轻不理想的患者。
我们回顾性分析了我们在新手术方面的临床经验。
从2008年3月至2014年12月，38例患者接受了修正手术。手术修正的适应症中，26例为直肠病，12例为体重减轻不理想。修正手术后，每天排便次数显著减少，体重也显著减轻（术前为87.1±21千克，术后第1年为69.2±13.5千克，第5年为68.1±11.9千克；p<0.001），同时BMI也相应降低（术前为33.03±7.6，术后第1年为26.8±4.1，第5年为26.9±2.8；p<0.）。术后第3个月平均超重BMI百分比损失为49.5±94.6%，第1年为76.51±74.9%，第5年为76.2±31.3%。营养和代谢参数保持稳定。分别分析两组患者时也观察到了类似结果。
我们的初步数据表明，所提议手术可能是一种安全有效的修正工具，可用于治疗SBPD后导致功能障碍的直肠病后遗症，或在体重减轻可能被认为不理想时使用。
