PubMed · 2597984
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E R Owen. 1989. Prader-Willi syndrome.. https://doi.org/10.1002/bjs.1800761136
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Biliopancreatic diversion (BPD) is a very effective bariatric operation particularly for super-obese patients (BMI > or = 50 kg/m(2)). 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.
BACKGROUND: The most commonly performed revision operation following failed vertical banded gastroplasty (VBG) is Roux-en-Y gastric bypass, although revision to biliopancreatic diversion (BPD) with duodenal switch is now another common option. We describe the surgical technique for revision of a failed VBG to a non-resectional Scopinaro BPD in a series of patients, as well as the outcome in terms of complications and mean % excess weight loss (%EWL). METHODS: A retrospective review was conducted on all patients who underwent revision to BPD at Mercy Bariatrics, Western Australia, between June 2001 and April 2005. This yielded 20 patients who had revision to BPD, 9 of whom had VBG as their initial operation. The mean %EWL was measured at regular intervals postoperatively (3, 6, 12, and 24 months). RESULTS: Mean %EWL at 12 and 24 months was 69.5 and 76.7, respectively. These results are comparable to %EWL after a primary BPD. Nutritional manifestations were found to be the most common of the minor complications. CONCLUSION: Our technique for revision of a failed restrictive operation to a non-resectional Scopinaro BPD is described. The preliminary results in terms of %EWL and complications are comparable to other revisional malabsorptive operations. Prospective randomized controlled trials are needed to further evaluate effects of revision to a non-resectional Scopinaro BPD and to ensure that the results (in terms of %EWL) are reproducible.
Obesity Surgery is not only capable to reduce body weight of the morbid obesity patients but also capable to treat complications such as Diabetes, Hypertension, Hyperlipemia and etc. From this point view, obesity surgery is recently called Metabolic Surgery, intending to treat Metabolic Syndrome. Gastric Bypass, Adjustable Gastric Banding, Vertical Banded Gastroplasty, and Biliopancreatic Diversion are widely recommended in the world. We have operated 97 cases of morbid obesity patients with various types of gastric bypass and gastroplasty since 1982. Laparoscopic surgery is induced in the field of obesity surgery around 1995, and since then, it has been exploring rapidly over the world. Two thirds of total cases are recently operated laparoscopicaly in the world. We adopted laparoscopic obesity surgery in 2000, and now several institutions are operating with laparoscopy even in Japan. Considering the characteristic features of Japanese obese, we should have our own guideline for obesity surgery. Patients who have BMI > or =35 and severe complications which need to be treated promptly should be applied to surgical treatment in Japan.