Biliopancreatic Diversion for Treatment of Morbid Obesity: Experience in 50 Cases

Background: Biliopancreatic diversion (BPD) by Scopinaro's method is an operation advocated by some surgeons as an effective treatment for morbid obesity. Methods: Between February 1995 and April 1997 we performed BPD by Scopinaro's method on 50 patients with morbid obesity (23 males), average age 41.4 years (range 20-63 years), average body weight 135.08 kg (range 89-256 kg), mean body mass index (BMI) 50.65 kg/m² (range 37.01-81.56 kg/m²). Results: In all cases a gradual decrease in weight was obtained [mean BMI at 1 month: 44.8 kg/m², at 6 months (31 patients): 35.09 kg/m², at 1 year (23 patients): 31.36 kg/m², at 18 months (14 patients): 29.89 kg/m² and at 2 years (5 patients): 29.27 kg/m²]. At the same time a significant improvement in the pathological conditions associated with morbid obesity was observed. The patients were able to suspend oral antihypertensive and antidiabetic therapy as these parameters spontaneously returned to normal values by the sixth postoperative month; all cases showed a marked reduction in hypercholesterolemia and hypertriglyceridemia. Postoperative complications were: one death (2%) on the third day due to heart failure; two late intestinal occlusions (4%); one acute dilatation of the stomach (2%); one peritonitis caused by early dehiscence of the anastomosis (2%); five anastomotic ulcers (10%); two cases of protein malnutrition (4%). Conclusions: BPD by Scopinaro's method is a bariatric procedure which is technically complex. However is it safe and reproducible and it induces a substantial weight loss.     

Results of Biliopancreatic Diversion in Two Patients with Prader-Willi Syndrome

Prader-Willi Syndrome (PWS) is a genetic disorder characterized by hypotonia, mental retardation or learning disability, hyperphagia and compulsive eating due to hypothalamic dysfunction. Obesity is a major cause of increased morbidity and mortality among patients with PWS. Gastric restrictive surgery has been associated with partial breakdown of the staple-line in PWS. We report two patients with PWS associated with morbid obesity and obstructive sleep apnea who underwent biliopancreatic diversion (BPD). A 27-year-old male with BMI 52 kg/m² and a 20year-old female with BMI 64 kg/m² underwent BPD. No perioperative complications were observed. After BPD, the male's BMI was 36.7 kg/m² at 12 months and the female's BMI was 48.4 kg/m² at 28 months, with excess weight loss 58% and 48%, respectively. They developed loose stools associated with eating. These patients have shown a considerable improvement in hypersomnia and respiratory difficulties. BPD proved to be an effective approach to weight loss in PWS, resulting in improvement of sleep apnea, behavior problems and quality of life.     

Results of Biliopancreatic Diversion after Five Years

Background: Gastric restrictive procedures, currently the most popular surgical operations for morbid obesity, have proved to be effective in initiating weight loss, but questions regarding their long-term efficacy in weight maintenance have arisen. Biliopancreatic diversion (BPD) is a mixed and complex technique that has shown good long-term results. There are no series with long-term follow-up of BPD in Spain. We present >5 year results (average 67.9 ± 15 SD mons, range 48-96), evaluating weight loss, morbidity and mortality after BPD. Methods: 74 patients who underwent BPD and completed 5 or more years of follow-up were studied. The results have been analyzed in terms of weight loss (classification of Reinhold), improvement in morbidity, and improvement in quality of life (BAROS). Results: 78.6% were women. Mean age was 38 ± 11 years (18-61). Mean preoperative body mass index (BMI) was 54 ± 8 kg/m². Progression of BMI: 1 year 34 ± 6, 2 years 31 ± 6, 5 years 33 ± 7 and 7 years 31 ± 3 kg/m² . Excess weight loss at 1 year follow-up was 67%, at 2 years 75%, at 5 years 70% and at 7 years 71%. There were significant differences between morbidly obese (BMI <50 kg/m²) and super-obese (BMI >50 kg/m² ), with better results in the morbidly obese group. Conclusion: BPD shows long-term effectiveness in weight loss, co-morbidity improvement and quality of life. Protein, vitamin and oligoelement deficits may appear in the long-term, so that strict follow-up and supplementation of deficiencies are necessary.     

Egyptian Experience in Laparoscopic Adjustable Gastric Banding (Technique, Complications and Intermediate Results)

Background: Surgery can provide effective longterm treatment for morbid obesity. The purpose of this study is to present an Egyptian experience of laparoscopic adjustable silicone gastric banding (LASGB) as a safe and effective treatment. Methods: 108 morbidly obese patients having body mass index (BMI) > 40 kg/m² were studied. 26 patients had a BMI > 50 kg/m² and < 60 kg/m², while 21 patients had a BMI ≥ 60 kg/m².The procedure was performed through a 4 or 5 trocar technique. Results: Mean age was 32.3 years. Mean BMI was 48.9 kg/m2. All except two procedures were completed by laparoscopy. Mean hospital stay was 2.2 days. Mean BMI after 12 months was 37.2 kg/m² and after 24 months was 34.3 kg/m². Mean follow-up was 2.1 years and included 87 patients (81%). Complications included: gastric perforation (1), pleural injury (1), liver injury (1), port complications (6), periband sepsis (1) and slippage (3).There were no mortalities in this series. Conclusions: LASGB proved to be safe and effective for the treatment of morbid obesity in Egyptian patients.     

Laparoscopic Adjustable Gastric Banding is a Safe and Effective Treatment for Morbid Obesity

Objective:

Surgery has been recognized as an effective long-term treatment for morbid obesity. The purpose of this study is to present our experience of laparoscopic adjustable gastric banding (LAGB) as a safe and effective treatment for morbid obesity.

Methods and Procedures:

Over eight months, 39 morbidly obese patients, having a Body Mass Index (BMI) >40 kg/m², were included in this study. Conservative measures failed to maintain weight loss in all patients. The procedure is performed through a 5-trocar technique. The procedure involves gastric partitioning and stoma formation by an inflatable band. The stoma can be adjusted by injection of saline in the band reservoir.

Results:

The mean age of the patients was 31.3 years. The mean BMI was 44.2 Kg/m². All procedures were completed laparoscopically. The mean hospital stay was 2.7 days. The morbidity rate was 15.32%. Patients were followed up for a mean period of 6.7 months. The mean BMI after six months (in 28 patients) was 36.6 Kg/m².

Conclusion:

Laparoscopic insertion of the adjustable gastric banding is a safe and effective method for the treatment of morbid obesity and should be the standard way of band insertion.     

Laparoscopic Reoperative Sleeve Gastrectomy for Poor Weight Loss after Biliopancreatic Diversion with Duodenal Switch

Background: The revisional surgery for patients with inadequate weight loss after biliopancreatic diversion with duodenal switch (BPD/DS) is controversial. It has not yet been determined whether a common channel should be shortened or gastric pouch volume reduced. Since the revision of the distal anastomosis remains technically difficult and associated with possible complications, we turned our attention to the reduction of gastric sleeve volume. This operation is more feasible and potential complications are less probable. Patient and Method: We present the case of a 47-year-old women with a life-long history of morbid obesity. She was operated on in January 2000 with a laparoscopic BPD/DS with 100 ml gastric pouch, 150 cm of alimentary limb and 100 cm of common channel. Before this operation, her weight was 170 kg, with BMI 64 kg/m². She lost most of her excess weight within 17 months after surgery and was regaining weight at 77 kg and BMI 29 kg/m². Upper GI series showed a markedly dilated gastric pouch. Her second surgery consisted of a laparoscopic sleeve partial gastrectomy along the greater curvature using endo GIA staplers with bovine pericardium for reinforcement of the stapler line. Results: No postoperative complications occurred. The patient was discharged on the first postoperative day. Significant further weight reduction was noted, and at 10 months after surgery, her weight is 61 kg with BMI 22. Conclusion: A repeat laparoscopic gastric sleeve resection was performed for inadequate weight loss after BPD/DS, and resulted in further weight reduction.     

Effectiveness of Biliopancreatic Diversion in the Patients with Bulimia Nervosa

Background: Bulimia nervosa (BN) is an eating disorder, characterized by consumption of huge amounts of food during discrete periods. Unlike patients with binge-eating disorder (BED), patients with BN demonstrate elements of compensatory "purging" behavior to prevent weight gain and obesity: i.e. self-induced vomiting, use of laxatives and enemas. These habits may prevent patients from attaining morbid obesity (MO), but may seriously affect life-style and become an excruciating, sometimes life-threatening condition. Methods: 6 of 108 patients (5.6%) who underwent BPD in our clinic (laparoscopic Scopinaro BPD - 1, open BPD/DS - 4, Lap. BPD/DS - 1) suffered from BN preoperatively. Their preoperative weight was 68-117 kg and BMI 27.6-41.9 kg/m². 4 of 6 patients had BMI <40 kg/m² before BPD but were MO in the past. The patient with the lowest weight had repeated gastroesophageal bleeding during self-induced vomiting. 3 of the 6 patients had previously failed intragastric balloon or Lap-Band^?. Results: All 6 patients were cured or significantly improved of bulimic symptoms soon after BPD. Weight loss was very good and never reached an undesirably low level. Patient satisfaction was high. Conclusion: Severe BN may be considered as a latent and potentially malignant MO. BPD (or BPD/DS) may be an effective solution for some patients with severe BN, as a final decision after unsuccessful organized conservative attempts. All candidates for bariatric surgery should be screened for BN, because it may influence choice of procedure in favor to BPD or BPD/DS.     

Combining Laparoscopic Adjustable Gastric Banding and Biliopancreatic Diversion after Failed Bariatric Surgery

Background: A percentage of all types of bariatric surgery will fail. Our experience with failed biliopancreatic diversion (BPD) as a primary operation or revision operation for failed laparoscopic adjustable gastric banding (LAGB) convinced us that uncontrolled hunger is often the underlying cause. To control hunger after failed bariatric surgery,a novel approach combining LAGB with BPD-duodenal switch (DS) has been tried. Methods: Patients who had failed to lose weight after BPD or LAGB were considered in 2 groups. Group 1: patients who had failed LAGB underwent laparoscopic BPD-DS without sleeve gastrectomy, with the LAGB left in-situ. Group 2: patients who had failed primary (subgroup 2a) or revision (subgroup 2b) BPD had a LAGB placed with no other revision of their surgery. Results: 11 patients have undergone this form of revision surgery with little morbidity. Mean age at the original operation was 45 years, mean (range) BMI was 45.3 (38-62) kg/m². After the reoperation, at 3 months (9 patients) mean BMI was 30 kg/m² and at 6 months (4 patients) mean BMI was 27 kg/m². Conclusion: In this small study, combination surgery was safe and effective for failed BPD or LAGB. LAGB failure may be best managed with DS malabsorption without gastric resection.     

Laparoscopic Gastric Bypass with Subtotal Gastrectomy for a Super-Obese Patient with Biermer Anemia

Laparoscopic Roux-en-Y gastric bypass (RYGBP) is a common procedure for morbid obesity. After RYGBP, the bypassed stomach is unavailable for follow-up. Biermer anemia is an autoimmune atrophic gastritis inducing vitamin B12 deficiency and it is a risk factor for gastric carcinoma.A 41-year-old woman with a long history of morbid obesity presented with a BMI of 56 kg/m². She had anemia (Hb 9.9 g/dL), and atrophic gastritis was found endoscopically. We performed a laparoscopic RYGBP with subtotal gastrectomy, to avoid the risk of gastric carcinoma in the bypassed stomach.The patient was discharged 9 days after the operation without complication. At 18 months follow-up, her BMI was 39 kg/m² (50% excess weight loss). Laparoscopic RYGBP with subtotal gastrectomy is a safe treatment for morbid obesity, which should be considered for patients with a risk factor for gastric carcinoma.     

Bariatric surgery in adolescence

Background/purpose: Surgical treatment for morbid obesity is relatively contraindicated in patients less than 18 years of age. However, on some occasions, there is extreme obesity in this age group that does not respond to nonsurgical treatment. The aim of this study was to evaluate the surgical management of severe morbid obesity in adolescents.Methods: During a 4-year period, the authors assessed 11 adolescent patients with severe morbid obesity. All patients underwent extensive preoperative evaluation including thorough psychological evaluation together with their families. Laparoscopic adjustable gastric banding (LAGB) was performed in all patients. Patients underwent follow-up for a mean of 23 months.Results: The mean age of the 11 children in this study was 15.7 years (range, 11 to 17 years). Associated conditions included heart failure and pulmonary hypertension in one patient, amenorrhea in 2 patients, and gallstones in 1 patient. Mean preoperative body mass index (BMI) was 46.4 kg/m² (range, 38 to 56.6). There were no operative complications. Over a mean follow-up period of 23 months (range, 6 to 36 months), the mean BMI dropped from 46.6 to 32.1 kg/m² with marked improvement in medical conditions and general psychologic well being. No late complications developed in any patient.Conclusions: Children are routinely excluded from bariatric surgery programs because of the difficulties involved in psychologically and cognitively preparing this population for surgery. However, extreme morbid obesity rarely responds to nonsurgical therapy for any extended period. This select population will benefit from bariatric surgery if an effort is made to properly prepare patients, together with their families, for the postoperative change in lifestyle and body image.     

Long-term weight loss outcomes after banded Roux-en-Y gastric bypass: a prospective 10-year follow-up study

Objective

To evaluate the weight loss outcomes of banded Roux-en-Y gastric bypass (RYGB) during a 10-year follow-up.

Changes In Lipid Profile after Biliopancreatic Diversion

Background: Bariatric operations have varying degrees of effectiveness and different mechanisms of action. Our objective was to evaluate the efficacy of the biliopancreatic diversion (BPD) in reduction of weight and serum lipids. Methods: A prospective study was conducted with follow-up from 12 to 72 months (average 39.4 months) of 58 patients with morbid obesity (10 men, 48 women, mean BMI 49.4 kg/m²). Their lipid levels were generally normal or slightly high. All the patients were subjected to subtotal gastrectomy and BPD with jejunoileostomy 50 cm proximal to the ileocecal valve, and they were instructed to maintain the same hypocaloric diet as before BPD. Serum lipoproteins and apolipoproteins B and A1 were measured before BPD and every 6 months during follow-up. Results: Early and very significant reduction (P<0.001) of total cholesterol (32.8%), LDL (46.3%), total cholesterol / HDL ratio (29.7%) and apolipoprotein B (37%), with more moderate decrease of triglycerides (21.3%, P=0.004), were observed. This lipid decrease was maximum at 1 year after BPD. Important and persistent weight reduction that did not correlate with changes in lipids was observed. The youngest patients and those with high basal lipid levels proved to benefit most from BPD. There were no important side-effects. Conclusion: BPD, with careful selection of patients, is a well tolerated procedure that offers excellent results in the short- and mid-term in reduction in weight and blood levels of most atherogenic lipoproteins.     

Two Years of Practice in Adjustable Silicone Gastric Banding (LAP-BAND™): Evaluation of Variations of Body Mass Index, Percentage Ideal Body Weight and Percentage Excess Body Weight

Background: In the treatment of morbid obesity, surgery had been the only method of obtaining a good and enduring weight loss. Although the procedure of choice is still a matter of debate, among gastric restriction procedures LAP-BAND™ has become our first choice. Methods: We report the results from 62 morbidly obese patients operated in the period October 1994-December 1996. Their characteristics were: mean age 35.6 years, mean body weight 130.6 kg, mean height 162.3 cm, mean body mass index (BMI) 49.9 kg/m², mean percentage ideal body weight (%IBW) 215.7 and mean excess weight (EW) 69.57 kg. Results: Twenty-four months after surgery we found a mean BMI of 39.3, a mean %IBW of 168.6 and a mean % EW loss of 88.5. We removed the band in two patients: one after 9 months because of stoma stenosis and pouch enlargement in a woman who had been lost at follow-up, and the other for gastric slippage occurring after 18 months due to incorrect fixation of the band. Conclusion: Our results led us to consider LAP-BAND™ as the surgical approach for severe obesity among those patients selected for gastric restriction; indeed, it was very safe as well as effective and was rarely followed by complications.     

Laparoscopic Adjustable Gastric Banding with Duodenal Switch for Morbid Obesity: Technique and Preliminary Results

Background: The procedure of choice for morbid obesity remains controversial. One of the most effective treatments is the biliopancreatic diversion with duodenal switch (BPD/DS), which is, however, associated with a significant morbidity rate. Adjustable gastric banding (AGB) by the laparoscopic approach is an easier procedure with the intent to reduce complication rates. It replaced the sleeve gastrectomy in this study. The objective was to assess the feasibility and safety of this new laparoscopic treatment. Methods: AGB with duodenal switch (DS) was performed laparoscopically with 7 trocars. A gastric band was appropriately placed below the gastroesophageal junction, followed by BPD/DS with a 250-cm alimentary channel and a 100-cm common channel. Results: All 5 patients were women, with mean preoperative BMI 52.2 kg/m² (40.6 to 64.4). The operations were performed via laparoscopy in a mean of 206 ± 35 minutes. There was no postoperative complication, infection or conversion. Mean hospital stay was 8.8 days (8-11). At 12 months, mean BMI is 35.8 kg/m² (26.1-46.0), with continuing weight loss and no hypoalbuminemia. Conclusions: These data suggest that laparoscopic AGB/DS is feasible, with a low morbidity rate. This technique could combine the long-term weight loss of malabsorptive procedures, with a low-morbidity, adjustable, restrictive procedure. This technique could be used in selected patients, but requires a larger study with longer follow-up.     

Impact of Gastric Banding on Plasma Adiponectin Levels

Background: Several endocrine abnormalities are reported in obesity. In an earlier study, we found that the changes in BMI following laparoscopic adjustable gastric banding (LAGB) were associated with changes in hormone profiles such as insulin and proinsulin. In the current study, we explored the changes in plasma adiponectin levels in morbidly obese subjects who lost abundant weight following LAGB. Methods: 23 adult morbidly obese patients (15 females), aged 21-56 years, were studied. Blood samples were collected before, and 6 and 14 months after LAGB. The plasma adiponectin levels were determined by commercial kit (B-Bridge International, Inc). Statistical analysis was based on one-way repeated measures ANOVA, followed by Student-NewmanKeuls post-hoc test. Regression model was used to look for predictors of adiponectin change after LAGB. Results: Mean BMI before surgery was 46.04±4.44 kg/m², and decreased significantly by 18% 6 months after surgery to 37.67±4.47 kg/m². BMI further decreased by 32% 14 months after surgery to a mean of 31.30±4.65 kg/m² (P =.000). The mean adiponectin level before surgery was 3997±1766 μg/ml, and increased significantly by 16% to 4763±1776 μg/ml 6 months after surgery, and to 6336±3292 μg/ml (37%) 14 months after surgery. Although BMI persistently decreased, while adiponectin persistently increased, BMI did not correlate with adiponectin. Conclusion: In morbidly obese patients who underwent LAGB, adiponectin levels persistently increased, probably due to the reduction of visceral fat mass. Adiponectin plasma increase was correlated with proinsulin levels prior to the surgery. The interaction between adiponectin, proinsulin and BMI change in morbid obesity merits further investigation.     

Is Bariatric Surgery Necessary after Intragastric Balloon Treatment?

Background: The use of the Bio-Enterics intra-gastric balloon (BIB) has been shown to be a safe and effective procedure for the temporary treatment of morbid obesity. We conducted a retrospective comparative analysis of the weight loss in patients that after BIB removal underwent bariatric surgery and those who did not wish surgery. Methods: From January 2000 to March 2004, 182 BIBs were positioned in 175 patients (104 F / 71 M; mean age 37.1±11.6 years, range 16-67; mean BMI 54.4 ± 8.1 kg/m², range 39.8-79.5; mean %EW 160.8±32.9% range 89-264). Patients were excluded from this study who had emergency BIB removal for balloon rupture (n=2, 1.1%) and for psychological intolerance (n=7, 7.8%). All patients were scheduled for a bariatric operation, before BIB positioning. After BIB removal, a number of patients now declined surgery. Consequently, patients were allocated into 2 groups: Group A in whom BIB removal was followed by bariatric surgery (Lap-Band^?, laparoscopic gastric bypass, duodenal switch) (n=86); Group B patients who after BIB removal refused any surgical procedure (n=82). Both groups were followed for a minimum of 12 months. Results were reported as mean BMI and %EWL ± SD. Statistical analysis was done by Student t-test or Fisher's exact test, with P<0.05 considered significant. Results: Mean BMI and mean %EWL in the 166 patients at time of removal were 47.3 ± 8.1 kg/m² and 32.1±16.6%, respectively. At the same time, mean BMI was 47.6±6.9 and 48.1±6.5 kg/m² in group A and B (P=NS). At 12 months follow-up (100%), mean BMI was 35.1 kg/m² in Group A (BIB + surgery) and 51.7 kg/m² in Group B (BIB alone) (P<0.001). Conclusions: After BIB removal, half (49.4%) of the patients scheduled for surgery refused a bariatric operation. These patients returned to their mean initial weight at 12 months follow-up. Therefore, bariatric surgery after BIB removal is highly recommended.     

Hand-assisted laparoscopic vertical banded gastroplasty: technique and analysis of the first 140 cases

Background:The use of laparoscopic surgery to perform bariatric operations offers advantages to morbidly obese patients. Between January 1999 and June 2001, 140 patients underwent hand-assisted laparoscopic VBG using the Handport^™ System. Methods: In the 110 females (78.6 %) and 30 males (21.4 %), mean age was 38 years (range 19-65), mean body weight 115.8 kg (range 89-200), and mean BMI 41.8. Severe obesity was present in 41%, morbid obesity in 41% and super obesity in 9% of the patients. Comorbid conditions included hyperlipidemia in 70% of patients, arthritis in 44%, hypertension in 38%, COPD in 18%, GERD in 12%, impaired glucose tolerance and diabetes in 10%, sleep-apnea in 5% and coronary heart disease in 1%. Results: There was no operative mortality. Mean excess weight loss was 60.7% at 12 months and 63% at 18 months. Mean BMI was 30.8 at 12 months and 30.4 at 18 months. A decrease in BMI of 11 kg/m² was reached at 12 months. According to the Reinhold Classification (residual excess weight <50%), good to excellent results were achieved in 75.7% at 1 year and in 77.7% at 18 months. Early postoperative complications were 4 wound infections, 3 atelectasis or pneumonia, 1 deep vein thrombosis, 1 subphrenic abscess and 1 wound hematoma. Late postoperative complications were 2 incisional hernias, 2 esophagitis, 1 symptomatic gallstones, 1 staple-line fistula, 9 protracted vomiting and 6 band-related problems. Conclusions: The short-term results compare favorably with the literature on open VBG. Because of the reduction of perioperative risks with the laparoscopic approach, bariatric surgery should be performed laparoscopically if the expertise is available.     

Micronutrient Deficiencies After Laparoscopic Gastric Bypass: Recommendations

Background  The aim of this study was to evaluate the changes of micronutrients in patients with morbid obesity after laparoscopic Roux-en-Y gastric bypass surgery (LRYGBP). Methods  We retrospectively reviewed 121 patients diagnosed with morbid obesity who undertook LRYGBP and evaluated the serum iron (Fe), calcium (Ca), zinc (Zn), selenium (Se), vitamin A (VitA), 25-hydroxy vitamin D3 (VitD), vitamin B₁₂ (VitB₁₂), and parathormone (PTH) measured at 6, 12, and 24 months after LRYGBP. Results  During a follow-up period of 69 months (June 1999 to February 2005), a cohort of 121 patients, 40 men and 81 women, underwent LRYGBP, a mean age of 46 years (range 22–67). The mean body mass index (BMI) before LRYGBP was 47.00 ± 7.15 kg/m² (range 30.65–76.60 kg/m²). After 6 months of the surgery, the mean BMI was 33.79 ± 6.06 kg/m² (range 21.70–52.76 kg/m²). The mean BMI decreased (P < 0.001) 6 months after the surgery. Within the following 2 years, the serum Fe, Ca, Zn, Se, VitA, VitD, and VitB₁₂ had normalized. The serum Zn, Se, and VitA of some patients decreased but were nearly normal. In contrast, serum PTH remained continuously at a higher level than normal. Conclusions  This study confirms that LRYGBP is a reliable and safe weight loss method for the patients suffering from morbid obesity. After surgery, serum Ca, Zn, and Se metabolisms and PTH levels are altered in these patients. Therefore, multi-vitamin and mineral supplementation are strongly recommended in all patients after LRYGBP.     

Laparoscopic Roux-En-Y Gastric Bypass is a Safe and Effective Operation for the Treatment of Morbid Obesity in Patients Older than 55 Years

Background: Bariatric surgery in patients >50 years has been controversial. We investigated the safety and efficacy of laparoscopic Roux-en-Y gastric bypass (LRYGBP) in patients >55 years of age. Methods: Prospective data on 71 patients (54 females and 17 males) undergoing LRYGBP were reviewed. The patients were followed for a mean of 17 months (range 2-35 months). Results: The mean age was 59 years (range 55-67 years), and the mean preoperative BMI was 50.2 kg/m² (range 37-65 kg/m²). There were no conversions to open technique. Mean percent of excess weight loss (%EWL) was 20%, 48%, 64% and 67% at 1, 6, 12 and 24 months respectively. 89% of patients had at least a 50% EWL at 1 year postoperatively. There was a significant decrease in the number of patients requiring medical treatment for co-morbidities associated with morbid obesity: diabetes mellitus 87%, hypertension 70% and sleep apnea 86%. There was no inpatient mortality. 1 patient died suddenly 2 weeks postoperatively of possible myocardial infarction or pulmonary embolism. 16 patients developed 22 complications. The median length of hospital stay was 3 days. Conclusion: LRYGBP is a safe and well-tolerated surgical option for the treatment of morbid obesity in patients >55 years old. These patients demonstrate a satisfactory weight loss and resolution of co-morbidities.     

Biliopancreatic Diversion with Duodenal Switch Combined with Laparoscopic Adjustable Gastric Banding

Background: The authors investigated the usefulness of an approach combining biliopancreatic diversion (BPD) with duodenal switch (DS) and laparoscopic adjustable gastric banding (LAGB) in morbidly obese patients. Methods: 258 morbidly obese patients underwent bariatric surgery. 80 underwent gastric bypass (GBP), with an 80-ml pouch, a 120-150-cm common channel and a 350-cm alimentary limb (Group 1). 178 underwent BPD combined with DS-LAGB (Group 2): an 80cm common channel and a 200-cm alimentary limb were created in 68 patients (Subgroup 2a); a 120-cm common channel and a 300-cm alimentary limb were created in 110 patients (Subgroup 2b). Quality of life was assessed using the Moorehead-Ardelt Quality of Life Questionnaire (MA-QLQ). Results: At 2 years, mean BMI and %EWL were 27.8 kg/m² and 77.4 (Group 1), 25.2 kg/m² and 99.6 (Subgroup 2a), and 27.6 kg/m² and 79.3 (Subgroup 2b), respectively. 4 GBP patients regained their weight 2 years after surgery. There was 1 death, not related to surgery in Subgroup 2b. Preoperative MA-QLQ scores were similar between groups; at 2 years, MA-QLQ scores were higher in Subgroups 2a and 2b compared to Group 1 (+2.49 and +2.59 vs +0.98, respectively). Conclusion: Combination bariatric surgery is a safe, effective and durable weight loss option for the treatment of morbid obesity.