Biliopancreatic Diversion Group Research Articles

Surgical treatment of morbid obesity with biliopancreatic diversion and gastric banding: report on an 8-year experience involving 235 cases

Study aim: Developments have recently been made in bariatric surgery outside the USA. The aim of this retrospective non-randomized study was to report on our experience regarding biliopancreatic diversion (BPD) and non-adjustable gastric banding (GB) in a population of 235 obese patients. Patients and methods: From March 1990 to March 1998, 235 obese patients were operated on, 142 by BDP and 93 by GB, via laparotomy after rigourous selection of the patient population. Results: The mean duration of surgery was 2 h 50 minutes for BPD and 1 h for GB. One postoperative death occurred due to massive pulmonary embolism. Early major complications were frequent in the BPD group ( n = 21) but rare in the GB group ( n = 1). Mean duration of hospitalization was 16 days in the BPD group versus 9 days in the GB group. Mean percentage excess weight loss was 48% for the GB group and 60% for the BPD group after two years. Late mortality was limited to the BPD group (3.5%). Late complications were evenly distributed between the two groups, with a prevalence of malnutrition in the BPD group and outlet stenosis in the GB group. A high incidence of band removal was recorded related to this complication (17.2%). Incisional hernias were present in both groups. Conclusions: GB and BPD are techniques which can induce weight loss and bring about subsequent health benefits. Nevertheless, in a few patients further intervention or adaptation of the approach due to clinical failure or to a high complication rate is required. Additional research is needed regarding determination of the surgical treatment that is best adapted to the case in question, i.e., taking into consideration both the restrictive and malabsorbative aspects.

Secondary hyperparathyroidism following biliopancreatic diversion.

To investigate the cause of osteomalacia following biliopancreatic diversion(BPD) surgery for obesity. A retrospective, case-comparison study. A tertiary care center. A case group of 12 subjects (including 9 women; mean age +/- SEM, 48.5 +/- 3.0 years; mean preoperative body mass index +/- SEM, 43.7 +/- 2.3 kg/m2, and mean weight loss +/- SEM, 75 +/- 14 kg) who have undergone BPD (referred to as BPD group hereafter) and a comparison group of 10 subjects (including 9 women; mean age +/- SEM, 49.6 +/- 3.3 years; mean preoperative body mass index +/- SEM, 44.0 +/- 2.5 kg/m2; and mean weight loss +/- SEM, 55 +/- 15 kg) following vertical banded gastroplasty (VBG) (referred to as VBG group hereafter). Serum and urine markers for bone metabolism. Compared with the VBG group, the BPD group had significantly lower concentrations of the following components: serum calcium (2.14 +/- 0.05 mmol/L vs 2.37 +/- 0.05 mmol/L [8.6 +/- 0.2 mg/dL vs 9.5 +/- 0.2 mg/dL]), serum 25-hydroxyvitamin D (24 +/- 6 nmol/L vs 64 +/- 6 nmol/L), urine calcium excretion (1.7 +/- 0.7 mmol/d vs 4.5 +/- 0.7 mmol/d [68 +/- 28 mg/d vs 180 +/- 28 mg/d]), and serum carotene (0.40 +/- 0.15 mmol/L vs 1.29 +/- 0.16 mmol/L). The BPD group had significantly higher concentrations of the following components: serum parathyroid hormone (13.6 +/- 2.1 pmol/L vs 5.2 +/- 2.3 pmol/L), serum alkaline phosphatase (139 +/- 8 U/L vs 86 +/- 9 U/L), and urinary hydroxyproline/creatine (52 +/- 5 mumol/mmol vs 19 +/- 5 mumol/mmol). These data suggest that following BPD, secondary hyperparathyroidism attributed to hypocalcemia results from malabsorption of vitamin D. However, we cannot exclude the possibility of concurrent calcium malabsorption with vitamin D malabsorption.