Laparoscopic Biliopancreatic Diversion: Technical Aspects and Results of our Protocol

Abstract

BPD can be performed satisfactorily by laparoscopy. Avoiding the gastrectomy is an interesting option to reduce technical difficulties, the surgeon's stress, duration of the operation, the patient's stress, and, probably, postoperative morbidity and mortality. We consider an upper digestive endoscopy to be mandatory to determine, before operating, if the patient will need a gastrectomy, depending on its results.

Obesity surgery: Evidence-based guidelines of the European Association for Endoscopic Surgery (EAES)

“…The integrity of all staple lines needs to be confirmed by methylene blue testing. To shorten the duration of surgery in high-risk patients, some authors have proposed to perform BPD either as a two-stage procedure with gastrectomy first (EL 4 [7,272]) or without gastrectomy (EL 4 [276]). …”

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

“…Hess [130] reported excellent results by measuring small bowel length and then distributing 10% to the common channel and 40% to the alimentary limb. A large Spanish series reports excellent outcomes with a common channel of 60 cm and an alimentary limb of 200-360 cm [131,132]. A U.S. study suggests that common channels longer than 100 cm result in inferior results [132].…”

“…For example, visits at 2 and 6 weeks, then quarterly for the first year, biannually for the second year, and annually thereafter would be one acceptable strategy [126,131]. Assessments are made by both the surgeon and the nutritionist, and biochemical surveillance by complete blood count, chemical metabolic profile, and parathormone level is performed at intervals.…”

SAGES guideline for clinical application of laparoscopic bariatric surgery

“…Hess [130] reports excellent results by measuring small bowel length and then distributing 10% to the common channel and 40% to the alimentary limb. A large Spanish series reports excellent outcomes with a common channel of 60 cm and an alimentary limb of 200-360 cm [131,132]. A US study suggests common channels longer than 100 cm result in inferior results [132].…”

“…For example, visits at 2 and 6 weeks, then quarterly for the first year, biannually for the second year, and annually thereafter would be one acceptable strategy [126,131]. Assessments are made by both the surgeon and nutritionist, and biochemical surveillance by complete blood count, chemical metabolic profile, and parathormone level is performed at intervals.…”