Early clinical and surgical results of biliopancreatic diversion

Background: Scopinaro biliopancreatic diversion (BPD) for morbid obesity results in significant long-term weight loss and reduction or resolution of obesity-associated co-morbidities. The aim of our work was to describe the early results after BPD. Methods: 59 morbidly obese patients (BMI > 40) underwent open BPD from December 2001 to December 2004. We analyzed a consecutive series of 19 patients who have been followed > 4 months. We present the data of basal and early visits (2 and 4 months). Results: Initial excess weight percent loss (IEW%L) was 5.2% at 2 months and 13.7% at 4 months. Glycemia, cholesterol, triglyceride levels and blood pressure improved at each visit. All parameters have significant differences from the basal values. 3 patients had sleep apnea syndrome, and overnight CPAP was able to cease in 2 patients by 4 months. 6 patients (31.5%) had albumin < 2.5 g/dl, without clinical findings of malnutrition. Total calorie (857 +/- 79.8 cal/day) and protein (59.8 +/- 23 g/day) intakes at 4 months were low, with a low intake of multivitamins and oligoelements from food. There was no mortality in this series. Early postoperative morbidity was incisional hernia (21.1%), anastomotic leak (5.2%), wound infection (15.7%), intra-abdominal infection (5.2%), and intestinal obstruction (5.2%). Conclusion: BPD showed early effectiveness in weight loss and co-morbidity improvement. Calorie, protein, oligoelement and vitamin dietary intakes were below recommendations, so that strict multidisciplinary follow-up and supplementation to prevent or treat nutritional deficiencies are mandatory.