BILIOPANCREATIC DIVERSION WITH A NEW-TYPE OF GASTRECTOMY - SOME PREVIOUS CONCLUSIONS REVISITED

Background: In 1990, we modified Scopinaro's biliopancreatic diversion (BPD); instead of a distal gastrectomy and gastroileal anastomosis, a parietal gastrectomy was performed with nutrients diverted through a duodenal switch. Also, the length of the common channel (50 cm) was do ubled to 100 cm, while the nutrient limb remained 250 cm. In 1991, we reported initial results after 16 months: weight loss was as expected following BPD, but patients reported fewer side-effects and the preval ence of excessive malabsorption was less. This cohort of patients had their duodenum stapled shut to construct the duodenal switch. This sta ple-line failed insidiously in some patients, allowing the duodenum to recanalize partially or completely. This resulted in an incomplete BP D. Methods: Since 1992, the duodenal switch has been constructed with a complete transection of the duodenum to prevent recanalization. We r eport here on the first 61 patients who underwent this definitive proc edure. Results: At 16 months, we observed a mean weight loss of 84% of initial excess weight, the number of daily stools at 2.9 +/- 1.6 and the prevalence of diarrhea at 10%. Twenty per cent of patients experie nced mild anaemia, hypocalcemia, or hypoalbuminemia, which required ad ded supplements. Conclusions: BPD with parietal gastrectomy, duodenal switch and longer common channel improved weight loss and decreased ga strointestinal side-effects without an increased prevalence of excessi ve malabsorption. The parietal gastrectomy may contribute to weight lo ss by increasing satiety, and decreasing side-effects by regulating ga stric emptying.