Complications of Biliopancreatic Diversion Surgery as Proposed by Scopinaro in the Treatment of Morbid Obesity

Abstract

BACKGROUND: This study concerns 33 patients treated for morbid obesity with the procedure proposed by Scopinaro. Results are reviewed retrospectively in terms of complication rates. METHODS: The group consisted of ten men and 23 women with a mean age of 34 years (range 20-51 years), and a mean BMI of 49.5 kg/m(2) (range 37-77). Adequate attempts at medical management had failed repeatedly. The operative procedure involved a 2/3 partial gastrectomy and biliopancreatic diversion by Roux-en-Y reconstruction 50 cm before the ileocecal valve. In one patient, a cholecystectomy was added. RESULTS: The mean weight loss after 6 months was 18.9% of the initial weight, with mean BMI 41 kg/m(2) (range 29-60). Early complications included four wound infections (15%), while two patients complained of an early dumping syndrome (6%), treated by dietary measures. There were no respiratory infections and no pulmonary embolism, likely as a result of the thoracic epidural anesthesia and high doses of prophylactic heparin used. There was no mortality. As to late complications, nine patients complained of diarrhea due to bacterial overgrowth (27%) and were treated with antibiotic therapy. There were five incisional hernias (15%). Five patients had a peptic ulcer (15%) and required medical treatment. Two patients had acute cholecystitis (6%). One patient had an afferent loop obstruction (3%), requiring reoperation. CONCLUSIONS: Overall, this series of intestinal diversion procedures by the method of Scopinaro had a larger complication rate than generally accepted.

Clinical application of laparoscopic bariatric surgery: an evidence-based review

“…Cholelithiasis postoperatively occurs in 6% of patients [155] to 25% [28]. Some surgeons advocate routine cholecystectomy given the alteration in endoscopic accessibility to the biliary tract, whereas others argue for delayed cholecystectomy only if symptoms develop because cholecystitis occurs uncommonly after BPD [156].…”

SAGES guideline for clinical application of laparoscopic bariatric surgery

“…Cholelithiasis postoperatively occurs in 6% [155] to 25% [28]. Some surgeons advocate for routine cholecystectomy given the alteration in endoscopic accessibility to the biliary tract, whereas others argue for delayed cholecystectomy only if symptoms develop, since cholecystitis occurs uncommonly after BPD [156].…”

Prompt Treatment of Intestinal Obstruction after Biliopancreatic Diversion can Save the Intestinal Loop

“…Intestinal obstruction after BPD operation has been reported with an incidence of 1-5% [10,11,14]. Previously reported reasons for intestinal obstruction are internal hernia, volvulus on an adhesion and compression of the intestine during pregnancy [15].…”

“…However, symptoms of biliopancreatic loop obstruction are not that straightforward, presenting with atypical abdominal pain, nausea, sometimes vomiting, preserved bowel motility, stool, and gas passage with normal upper GI X-ray. In these cases, CT or ultrasound have proven helpful [14,16]. Considering the possibility of insidious presentation of intestinal obstruction after BPD, especially in case of obstructed biliopancreatic loop [10,11,14,16], the postponement of an operation is a likely possibility.…”

“…1) of the Scopinaro [5] and Marceau [6] techniques. The procedure itself has both long-term non-surgical complications, such as anemia [7], bone demineralization [7,8], and protein malnutrition [9], and long-term surgical complications, such as intestinal obstruction [10,11,14] and postanastomotic peptic ulcer [10,12,13].…”