MANAGEMENT OF BILIOPANCREATIC DIVERSION COMPLICATIONS

Background: In our Centre of bariatric surgery, active since 1974, we have never utilized the biliopancreatic diversion (BPD)for its incomplete reversibility and its surgical aggressiveness but, from the beginning of 80\u2019s, we have hospitalized for severe complications 20 patients who underwent this procedure in different centres and in different times. Here, we report our experience of management of BPD complications, particularly with reference to the last 7 patients treated in the last 3 years.All the patients were operated on the same type of BPD. Methods: The patients are all females, mean age 42.5 years (25 \u2013 47); mean weight pre-BPD 92.5 Kg (82 \u2013 114); mean weight at the moment of hospitalization 65 Kg (55-89); mean BMI pre-BPD 35,6 (34 \u2013 45); mean BMI at the moment of the hospitalization 25,3 (20 \u2013 36);mean follow-up 9,5 years (2 - 17).We observed these complications: insufficient weight loss (1 patient : from 91 to 89 Kg); excessive weight loss for persistent malabsorption ( 3 pts); severe osteomalacia for alteration of calcium and vitamin D metabolism (2 patients), 1 with spontaneous pertrocanteric fractures; severe hypoproteinemia ( 7 pts ); iron deficiency anaemia ( 6 pts). One patient had numerous haematic transfusions; severe and late dumping syndrome (1 pt); halitosis (3 pts); persistent diarrhea more than 5 evacuations/day (1 pt); liver failure (1 pt). Six patients were treated with hyperproteic and hypercaloric parenteral nutrition (PN), and with polyelectrolytes and polyvitaminics endovenous infusion for more than 60 days, in the hospital and/or at home, till to gain an acceptable metabolic balance.We have converted 3 patients to adjustable gastric banding according to Kuzmak and 2 patients had reversal; the others are still under medical care. Results: Hyperproteic and hypercaloric parental and oral nutrition obtained in all patients a good metabolic balance. Three patients didn\u2019t achieve a stable metabolic balance at the end of PN so that it was necessary a reversal of BPD or conversion to adjustable gastric banding in accordance with the patient, the internist and the psychologist. One patient had reversal for psychological indication.Post-operative course was uneventfull for 2 patients; 1 patient had an acute hemorrhagic gastritis in the first post-operative day, treated with medical care. One patient had a revision for intestinal occlusion. The patient who had an insufficient weight loss after BPD, had a good result after adjustable gastric banding (from 89 to 70 Kg, BMI 25).The other patients had an increase of 20 Kg one year after reversal. Conclusion: Our experience permits to underline that: 1) BPD can be better used in the morbidly obese patients with BMI > 40; 2) the choise of the patients must be careful, particulary by psychological point of view; 3) BPD requires a continous, constant and rigorous follow-up to prevent or to opportunely treat the metabolic complications such as all malabsorption bariatric procedures. These all complications can be successfully traited medically or surgically; 4) BPD doesn\u2019t permit the complete reversibility because of gastrectomy but only a partial functional one; 5) the metabolic complications and the failures of BPD can be treated by conversion into adjustable gastric banding