Derivação biliopancreática com preservação gástrica videolaparoscópica: sistematização técnica

Abstract

Background: The authors describe a videolaparoscopic technical variation of biliopancreatic diversion, and its rationale, as well as its preliminary results.They operated on 12 female patients, age between 26 and 49 years, BMI range 47,4 and 59,5kg/m 2. There were no intraoperative complications; operative time ranged from 2 to 4,5 hours; discharge in the 3rd. postoperative day. Liquid dietetic recommendations in the early period, and normal diet after the first week. One patient was readmmitted after 1 week with abdominal pain because of excessive ingestion of food; there was deep venous trombosis in one patient. Follow-up showed loss of excess weight of 27,4% after four months. Initial results of the described operation sugests it may be a good alternative to morbid obesity surgical treatment; it is strongly required a multidisciplinar pre and postoperative treatment program.

Operação de Scopinaro modificado na falha da banda gástrica

“…Specific deficiencies in the late follow-up of biliopancreatic diversion are found from 1.5% to 14.5% of patients in relation to low vitamin A, D, K, iron, folic acid, calcium and protein. To avoid such complications, it is suggested systemic use (early years) of proton pump inhibitor, calcium and vitamin supplement, with daily minimum intake of 100g of protein per day, avoid to eat fat and blood analysis every six months for monitoring 6,15 . The bileopancreatic derivation has been increasingly accepted because it allows a small restrictive gastric pouch with a capacity of 500 ml volume and weight loss that is independent of the quantity and quality of food ingested, besides, provide a reduction in the absorption of starch and fat 5 .…”

“…The weight loss tends to stabilize within a year and the rate of serious surgical complications is generally low 19,20 . In order to simplify the procedure proposed by Scopinaro, Domene in our country, has proposed a technical modification and tactical biliopancreatic shunt by laparoscopy without the need for removal of the body and gastric antrum with satisfactory results in the short and long term 6,9 . When it is necessary a reoperation in patients who underwent adjustable gastric banding due to method failure, there may be some difficulties in dissection of the esophagogastric area compromising the use of other procedures, such as gastric bypass or vertical gastroplasty.…”

Cirurgia de Scopinaro com preservação gástrica: análise precoce e tardia das complicações e da evolução do diabetes

“…Estes fatores -complexidade técnica e elevado índice de complicações -ajudam a explicar parcialmente a baixa adesão dos cirurgiões às derivações biliopancreáticas, que nunca ultrapassaram 2% do total de procedimentos bariátricos realizados em todo o mundo 2,5,6. OBJETIVO O presente trabalho analisa as complicações pós-operatórias e resultados tardios de 1570 pacientes operados por derivação biliopancreática com preservação gástrica videolaparoscópica (Domene et al, 2001) com até 20 anos de seguimento pósoperatório.…”