Philippe A Topart1, Guillaume Becouarn2. 1. Clinique de l׳Anjou, Société de Chirurgie Viscérale, Angers, France. Electronic address: ptopart@gmail.com. 2. Clinique de l׳Anjou, Société de Chirurgie Viscérale, Angers, France.
Abstract
BACKGROUND: Biliopancreatic diversion is a powerful bariatric procedure that relies on gastric restriction combined with a large malabsorptive component. This can lead to excessive side effects and/or weight loss. Despite this, long-term weight regain can also occur. OBJECTIVES: To determine the rate of and options for revision in patients who experience excessive side effects and weight loss. To explore the revisional procedures available to overcome weight regain. METHODS: A PubMed search was conducted of all reports published between 1979 and August 31, 2014. Series and case reports on revision or reversal after biliopancreatic diversion with duodenal switch (BPD/DS) or without (BPD) were included. RESULTS: Revision rates for excessive malabsorption ranges from .5%-4.9% and 3%-18.5% after BPD/DS and BPD respectively. Revisions increase common channel by up to 150 cm. Reversal is necessary in .2%-7% of cases, with an increased risk when the common channel is ≤ 50 cm. In most instances, reversal (of the malabsorptive component only) is indicated after the revision failure. A proximal, side-to-side anastomosis between the biliopancreatic and alimentary limbs is the preferred option. Most reoperations are performed within 2 years of the initial procedure and for protein malnutrition in about half of the cases. Revision for insufficient weight loss is reported in .5%-2.78% of cases. Except inadequate channel lengths, little is to be gained by common channel shortening. Additional gastric restriction, which results in an average 9-14 kg weight loss, is another option. CONCLUSIONS: Biliopancreatic diversion can be relatively easily revised to control excessive side effects and protein malnutrition. Early diagnosis is essential and warrants a close nutritional monitoring. In case of weight regain, limited results can be obtained by reducing the gastric volume provided the lengths of the small bowel channels are adequate.
BACKGROUND: Biliopancreatic diversion is a powerful bariatric procedure that relies on gastric restriction combined with a large malabsorptive component. This can lead to excessive side effects and/or weight loss. Despite this, long-term weight regain can also occur. OBJECTIVES: To determine the rate of and options for revision in patients who experience excessive side effects and weight loss. To explore the revisional procedures available to overcome weight regain. METHODS: A PubMed search was conducted of all reports published between 1979 and August 31, 2014. Series and case reports on revision or reversal after biliopancreatic diversion with duodenal switch (BPD/DS) or without (BPD) were included. RESULTS: Revision rates for excessive malabsorption ranges from .5%-4.9% and 3%-18.5% after BPD/DS and BPD respectively. Revisions increase common channel by up to 150 cm. Reversal is necessary in .2%-7% of cases, with an increased risk when the common channel is ≤ 50 cm. In most instances, reversal (of the malabsorptive component only) is indicated after the revision failure. A proximal, side-to-side anastomosis between the biliopancreatic and alimentary limbs is the preferred option. Most reoperations are performed within 2 years of the initial procedure and for protein malnutrition in about half of the cases. Revision for insufficient weight loss is reported in .5%-2.78% of cases. Except inadequate channel lengths, little is to be gained by common channel shortening. Additional gastric restriction, which results in an average 9-14 kg weight loss, is another option. CONCLUSIONS: Biliopancreatic diversion can be relatively easily revised to control excessive side effects and protein malnutrition. Early diagnosis is essential and warrants a close nutritional monitoring. In case of weight regain, limited results can be obtained by reducing the gastric volume provided the lengths of the small bowel channels are adequate.
Authors: Ramon Vilallonga; José Maria Balibrea; Anna Curell; Oscar Gonzalez; Enric Caubet; Andrea Ciudin; Angel Michael Ortiz-Zúñiga; José Manuel Fort Journal: Obes Surg Date: 2017-12 Impact factor: 4.129
Authors: Gladys W Strain; Mehyar H Torghabeh; Michel Gagner; Faith Ebel; Gregory F Dakin; Jonathan S Abelson; Daniel Connolly; Alfons Pomp Journal: Obes Surg Date: 2017-03 Impact factor: 4.129