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1.
Background: The influence of the new anatomicofunctional structure created by biliopancreatic diversion (BPD) in the postoperative
fall of serum leptin concentration was evaluated. Methods: Serum leptin concentration was determined in obese women before
and immediately after BPD, before the usual postoperative intestinal rest. The measurements were repeated at the second postoperative
month, when oral intake had nearly totally resumed and the patients had lost the first amount of weight. Results: 5 days following
BPD, a sharp reduction of serum leptin concentration was observed. At the second postoperative month the values remained nearly
unchanged and were indistinguishable from those observed in a group of obese non-operated patients with a closely similar
body weight. Conclusions: Changes in the upper gastrointestinal tract due to BPD appear to have no influence in the postoperative
reduction of serum leptin concentration, which appears to be substantially related only to the patient's adiposity. 相似文献
2.
Primavera A Brusa G Novello P Schenone A Gianetta E Marinari G Cuneo S Scopinaro N 《Obesity surgery》1993,3(2):175-177
Wernicke-Korsakoff disease with sensory-motor neuropathy was diagnosed in three out of a series of 1663 patients (0.18%),
with onset 2, 3 and 5 months after biliopancreatic diversion. Precipitating factors were vomiting, minimal food intake, anorexia,
rapid weight loss, and glucose-containing intravenous feeding. Recovery was partial in two and complete in one of the patients.
In the early postop, prophylactic thiamine should be given to the patients with excessively limited eating capacity. Larger
doses of thiamine should be instituted parenterally either in the case of suspected Wernicke-Korsakoff encephalopathy or before
starting feeding for protein malnutrition. 相似文献
3.
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. 相似文献
4.
Adami GF Parodi RC Papadia F Marinari G Camerini G Corvisieri R Scopinaro N 《Obesity surgery》2005,15(9):1233-1237
Background: Intramyocellular content of lipid (IMCL) appears to be important in the pathogenesis of insulin resistance, and
the improvement of insulin activity observed following biliopancreatic diversion (BPD) for obesity has to be related to reduction
of IMCL. This study evaluates the possibility of detecting changes after BPD in IMCL by means of H1 magnetic resonance spectroscopy. Methods: The investigation was carried out in obese patients undergoing BPD prior to and
at 1 month following the operation. Insulin sensitivity was assessed according to the homeostatic model of assessment (HOMA),
and IMCL was determined by the spectroscopy of the tibialis anterior muscle. Results: At 1 month following BPD, an improvement
in insulin action was observed in all subjects, and in nearly all cases the IMCL signal decreased. Conclusion: The data from
this study indicate that magnetic resonance spectroscopy can detect IMCL changes following BPD and is fully suitable for longitudinal
studies on muscle metabolic status. 相似文献
5.
Miriam Cornicelli Gloria Noli Giuseppe M. Marinari Gian Franco Adami 《Obesity surgery》2010,20(9):1278-1280
Aim
This study aims to evaluate the role of simple carbohydrates and alcohol intake in determining weight of stabilization at long-term following malabsorptive bariatric surgery. 相似文献6.
Biliopancreatic Diversion with a Duodenal Switch 总被引:12,自引:0,他引:12
Background: This paper evaluates biliopancreatic diversion combined with the duodenal switch, forming a hybrid procedure which
is a combination of restriction and malabsorption. Methods: The evaluation is of the first 440 patients undergoing this procedure
who had had no previous bariatric surgery. The mean starting weight was 183 kg, with 41% of our patients considered super
morbidly obese (BMI > 50). Results: There was an average maximum weight loss of 80% excess weight by 24 months postoperation;
this continued at a 70% level for 8 years. Major complications were found in almost 9% of the cases. There were two perioperative
deaths, one from pulmonary embolism and one from acute pulmonary obstruction. There were 36 type II diabetics, all of whom
have discontinued medication following the surgery. Seventeen revisions were performed to correct excess weight loss and low
protein levels. There have been no marginal ulcers, no cases of dumping syndrome, no foreign material used, and the procedure
is a pyloric saving procedure which is functionally reversible. Conclusions: This operation has vastly improved the lives
of seriously obese patients with many co-morbidities. All type II diabetics have essentially been cured of their disease.
The procedure was tolerated well and patients are quite satisfied. There was minimal regain of weight with this method. 相似文献
7.
Manco M Castagneto M Nanni G Guidone C Tondolo V Greco AV Gasbarrini G Mingrone G 《Obesity surgery》2005,15(2):286-289
Background. The HAIR-AN syndrome is a rare multisystem disorder in women, that consists of hyperandrogenism (HA), insulin resistance (IR) and acanthosis nigricans (AN). The IR is likely due to a primary defect of the insulin receptor. Methods: We report the case of a 42-year-old Caucasian
woman with HAIR-AN syndrome, impaired glucose tolerance (IGT), mild hyperlipemia, and hypertension, who underwent biliopancreatic
diversion (BPD). Results: Within 24 months follow-up after BPD, impaired glucose tolerance, mild hyperlipemia, and hypertension
completely reversed. Although insulin sensitivity, estimated by the euglycemic hyperinsulinemic clamp, did not improve, signs
and symptoms of hyperandrogenism and acanthosis nigricans resolved fully. Conclusion: In HAIR-AN syndrome, malabsorptive bariatric
surgery is effective in improving hyperandrogenism and acanthosis nigricans, with noteworthy esthetic consequences. BPD was
followed by disappearance of co-morbidities of the syndrome, such as IGT, hypertension and hyperlipemia. 相似文献
8.
José Antonio Balsa José I. Botella-Carretero Roberto Peromingo Carmen Caballero Teresa Muñoz-Malo Juan J. Villafruela Francisco Arrieta Isabel Zamarrón Clotilde Vázquez 《Obesity surgery》2010,20(4):468-473
Background
Biliopancreatic diversion (BPD) is the most effective bariatric procedure. Around 70% of these patients have secondary hyperparathyroidism (SH) in the long term as a consequence of calcium and vitamin D malabsorption. This work was aimed to study the influence of SH on bone turnover and its relationship with bone mineral density (BMD). 相似文献9.
López Deogracias M Domínguez-Diez A Palomar-Fontanet R González-Noriega M Rodrigo E Fernández-Fresnedo G Zubimendi JA Olmedo F Gómez-Fleitas M Arias M Fernández-Escalante C 《Obesity surgery》2007,17(4):553-555
Surgery is usually the only solution to modify the evolution of morbid obesity and resolve the associated co-morbidities.
There is very little written regarding malabsorptive surgery and transplantation. A 48-yearold male with hypertension, hyperuricemia
and obesity underwent renal transplantation in 1994 for renal amyloidosis. He was maintained on oral immunosuppressive cyclosporine.
The patient developed uncontrollable hypertension, hyperlipemia, hyperglycemia and increasing weight to a BMI of 44. Thus,
in December 2004, he underwent biliopancreatic diversion (BPD). After 18 months follow-up, he has lost 85% of his excess weight,
and his hypertension, hyperglycemia and hyperlipemia are markedly improved. Renal function was not modified, nor were the
levels of cyclosporine. He has had no complications derived from the BPD, and has a better quality of life. 相似文献
10.
BACKGROUND: This study describes the pregnancy of previously obese women with type 2 diabetic who reduced body weight and normalized serum glucose level following biliopancreatic diversion (BPD) for obesity. METHODS: A subset of ten women who had type 2 diabetes prior to BPD and who developed pregnancy after the operation was retrospectively identified. RESULTS: All pregnancies were completely normal, and serum glucose levels remained within the physiological range throughout all the pregnancy. These post-diabetic women delivered 13 infants in good health with a normal birth weight and no case of macrosomia. CONCLUSIONS: These data are a clinical confirmation of the post-BPD improvement of beta-cell response to increased functional demand in obese patients with preoperative type 2 diabetes. 相似文献
11.
Biliopancreatic Diversion with a New Type of Gastrectomy 总被引:4,自引:0,他引:4
In an attempt to improve the results of biliopancreatic diversion in the treatment of morbid obesity, two aspects of the procedure
performed at Laval Hospital were modified to reduce adverse physiological consequences. The distal gastrectomy was replaced
by a parietal gastrectomy which preserves vagal continuity along with the lesser curvature, and leaves intact the antro-pyloro-duodenal
pump. The duodenum was stapled shut and nutrients were diverted through a duodeno-ileal anastomosis. The biliopancreatic diverting
intestinal limb was anastomosed to the nutrient ileal limb 100 cm proximal to the ileocaecal valve instead of 50 cm proximal
to it, thus doubling the length of the common ileal absorptive segment. Weight loss after either operation was greater than
70% of initial excess weight. Following the new operation, there was a lesser prevalence of side-effects, especially loose
stools and malodorous gas, a lesser degree of hypocalcemia and no hypoalbuminemia. The duodenum recanalized at the staple
line in 20% of the patients who had the new operation. When data from these patients were excluded, weight loss following
the new operation was greater than that seen after the old one. The prevalence of side-effects and the degree of calcium and
protein malabsorption remained significantly lower. Weight loss remained satisfactory with a common limb measuring 100 cm.
The parietal gastrectomy was not restrictive as shown by the failure to lose further weight when the duodenal stapled diversion
failed. Weight loss was thus mainly a function of biliopancreatic diversion, but increased weight loss in the new procedure
despite a doubling of the common ileal limb suggests that parietal gastrectomy contributed to weight loss. Because duodenal
recanalization can be corrected surgically and now prevented, the modified biliopancreatic bypass is preferred. 相似文献
12.
Biliopancreatic diversion (BPD) is a very effective bariatric operation particularly for super-obese patients (BMI ≥50 kg/m2). We present the development of a stricture at the gastro-ileal anastomotic site, with subsequent dilatation and aperistalsis
of the stomach in a female patient who had undergone a standard open Scopinaro BPD. The patient remained symptomatic and persisted
in losing weight, despite endoscopic balloon dilatations of the stricture and surgical revision of the anastomosis. She finally
underwent conversion to a standard Roux-en-Y proximal gastric bypass. We describe the development of the stricture after the
use of the stapling gun, subsequent gastric dilatation and dysmotility. 相似文献
13.
Scopinaro N 《Obesity surgery》1991,1(3):307-309
The author discusses why his operation of choice is biliopancreatic diversion (BPD). BPD is the most effective in obtaining
long-term weight loss and permits unchanged eating habits. Although BPD is technically demanding, revisions for protein malnutrition
or stomal ulcer have not been difficult and have become infrequent. However, lifelong follow-up must be guaranteed. 相似文献
14.
15.
Anny Aasprang John Roger Andersen Villy Våge Ronette L. Kolotkin Gerd K. Natvig 《Obesity surgery》2013,23(10):1662-1668
Background
Long-term data of health-related quality of life (HRQL) after biliopancreatic diversion with duodenal switch (BPDDS) procedure are lacking. The aim of this study was to evaluate changes in HRQL from baseline to 5 years after BPDDS.Methods
Fifty morbidly obese patients were followed for 5 years after BPDDS procedure. The sample consisted of 27 women and 23 men, the mean age was 37.8 years, and the mean body mass index (BMI) was 51.7 units. HRQL was measured with the Short Form 36 questionnaire (SF-36). Anxiety and depression were measured with the Hospital Anxiety and Depression Scale (HADS). Linear mixed model was used to investigate the change scores. The SF-36 scores and HADS scores of the sample were also compared with a Norwegian population norm, adjusted for age, gender, and BMI.Results
Mental summary scores (MCS) and physical summary scores (PCS) were very low preoperatively but significantly improved (P?<?0.05) 5 years after surgery. The PCS was comparable to the population norm, while MCS was lower. Depression improved significantly from baseline to the 5-year follow-up (P?=?0.004), but anxiety did not (P?=?0.595).Conclusions
This study demonstrates a sustained weight loss and improved, although somewhat fading, HRQL scores 5 years after BPDDS. The study also shows that BPDDS is associated with a sustained reduction in depression symptoms but not in anxiety symptoms. 相似文献16.
Markos Daskalakis Oliver Scheffel Sophia Theodoridou Rudolf A. Weiner 《Obesity surgery》2009,19(12):1617-1623
Background
Reoperations due to failures constitute an essential but challenging part of bariatric surgery practice today. The aim of this study was to evaluate the perioperative safety, efficacy, and postoperative quality of life in patients with biliopancreatic diversion (BPD), after failed vertical banded gastroplasty (VBG). 相似文献17.
López-Tomassetti Fernandez EM Arteaga González I Díaz Luis H Carrillo Pallarés A 《Obesity surgery》2007,17(7):989-992
A case is reported of a woman who developed untreatable diarrhea after a prior biliopancreatic diversion (BPD), attributed
to the malabsorptive component. Abdominal ultrasound incidentally found focal liver lesions. On fine needle aspiration biopsy,
atypia was found, and these hepatic lesions were resected with free margins. The specimen showed liver metastases of an aggressive
malignant neuroendocrine neoplasm. The primary site was subsequently identified to be in the pancreas. The physician and surgeon
must realize that non-related diseases can develop after bariatric surgery, as in the general population. 相似文献
18.
Luc L 《Obesity surgery》1993,3(2):179-180
During the past 7 years, 170 morbidly obese patients have been subjected to a biliopancreatic diversion. Mean weight loss
achieved over 2 years was greater than 70% of excess weight and was maintained. Early complications were rare. The most common
side-effects are discussed. The re-operation rate because of these side-effects was 7%. Eating normal meals, together with
a stable weight loss, has provided these patients with a better quality of life. 相似文献
19.
Our group has performed the Roux-en-Y gastric bypass (RYGB) in 1450 patients since 1983: 805 patients had primary operations,
and 645 were converted from previous gastroplasty procedures, i.e. horizontal gastroplasty, vertical banded gastroplasty,
and gastrogastrostomy. Within the last 2 years, 38 patients who failed the RYGB were converted to a modified biliopancreatic
diversion (BPD) using a technique that did not require dismantling a major portion of the original gastric exclusion. A 24-month
follow-up has demonstrated a significant and sustained weight loss in all patients. In addition, the modified BPD completely
eliminated the problem of reflux bile gastritis in those patients with a short Roux-en-Y jejunal limb. 相似文献
20.
Splenic artery pseudoaneurysm (SAP) is a known but rare complication of pancreatitis and blunt abdominal trauma. SAP caused by operative trauma has been rarely reported. We present a patient who presented with massive upper gastrointestinal (GI) bleed in shock. On exploratory laparotomy, a SAP was diagnosed. He must have sustained injury to his splenic artery while undergoing reinforcement of sleeve gastrectomy during an open biliary pancreatic diversion procedure 2 years back. Alternatively, the prolene suture might have eroded into the splenic artery to cause the SAP. Literature on iatrogenic SAP is reviewed. SAP should be considered in patients with history of foregut surgery with GI bleed and equivocal endoscopic findings. 相似文献