E. Traverso

Pregnancies in an 18-Year Follow-up after Biliopancreatic Diversion

Background: 239 pregnancies occurred in 1136 women who had undergone biliopancreatic diversion (BPD). Methods: There were 73 abortions, and 14 pregnancies are presently in their course. The 152 term pregnancies (six twins) occurred in 129 women 2-173 months (mean 42.7) after BPD. Mean age and current excess weight were 31.4 years (20-42) and 29.1% (-6.9-78.2), and mean excess weight loss was 72.9% (30.4-110.5). Results: Mean weight gain during pregnancy was 6.2 kg (-21-25). In 32 patients (21%), parenteral nutritional support was needed. In all the other patients (79%), the usual supplementations were given. Of the newborns, 122 were delivered at term (84.7%) with a mean weight of 2842.4 g (1760-4600 g) and a mean length of 48.5 cm (43-59 cm), while the 22 preterm babies (15.3%) weighed 2151.1 g (1400-3850 g) and had a length of 44.6 cm (33-56 cm). Forty infants (27.8%) were small for gestational age but 17 of them weighed more than 2500 g. Eleven twins (one abortion at 26th week) were also delivered, with a mean weight of 2088.6 g (1200-3100 g) and a mean length of 45.6 cm (35-50 cm). Delivery was spontaneous in 85 instances (56%), while vacuum extractor was used in one, and 66 cesarean sections were performed. There were two birth malformations, one infant died after surgery for meconium obstruction and two died from unknown causes. Of the 129 women, 35 had been infertile before BPD. Conclusions: Disappearance of infertility and decrease of pregnancy risk are to be considered among the beneficial effects of weight reduction following BPD.

Long-term results of biliopancreatic diversion in the treatment of morbid obesity

SummaryBackground: The continuing evolution and the mechanisms of actions of biliopancreatic diversion (BPD) as malabsorptive approach to the surgical treatment of obesity are evaluated. Methods: In a series of 2273 patients operated on during the last 21 years, BPD was progressively modified in order to adapt the operation to the individual patients’ characteristics. Results: There was a mean permanent reduction of about 75% of the initial excess weight. The other beneficial effects, besides those consequent to weight loss and/or reduced nutrient absorption, included permanent normalization of serum glucose and cholesterol without any medication and on totally free diet in 100% of cases, both phenomena being due to a specific action of the operation. Operative mortality was less than 0.5%. Specific late complications included: anemia, less than 5% with adequate iron and/or folate supplementations; stomal ulcer, reduced to 3.0% by oral H2-blockers prophylaxis; bone demineralization, increasing up to the fourth year and tending to decrease thereafter, with need of calcium and vitamin D supplementation; neurological complications, totally avoidable by prompt vitamin B administration to patients at risk; protein malnutrition, which was reduced to a minimum of 2.8% with 1.2% recurrence, in exchange with a smaller weight loss, by adapting the volume of the gastric remnant and the length of the alimentary limb to the patient’s individual characteristics. Conclusions: The correct use of BPD, based on the knowledge of its mechanisms of action, can make the procedure a very effective and safe one in all hands.ZusammenfassungGrundlagen: Die kontinuierliche Entwicklung und der Aktionsmechanismus der biliopankreatischen Umleitung als Malabsorptionsmethode in der chirurgischen Behandlung der Adipositas werden erforscht. Methodik: In einer Serie von 2273 Patienten, die in einem Zeitraum von 21 Jahren operiert wurden, ist die Methode zunehmend modifiziert und den individuellen Gegebenheiten der Patienten angepaßt worden. Ergebnisse: Eine durchschnittliche permanente Reduktion des initialen Überschußgewichtes von 45% wurde erzielt, einhergehend mit einer Normalisierung von Cholesterin und Blutzucker. Die operative Mortalität lag unter 0,5%. Spezifische Spätkomplikationen sind: Anämie (5%), Anastomosenulkus (3%), Knochendemineralisation und Eiweißmangel. Schlußfolgerungen: Die korrekte Anwendung der biliopankreatischen Umleitungsoperation, basierend auf dem Wissen und dem Aktionsmechanismus, kann den Eingriff zu einer sicheren und wirkungsvollen Methode in der Behandlung der morbiden Adipositas machen.