Complications and Late Follow-Up of Scopinaro’s Surgery With Gastric Preservation: 1570 Patients Operated in 20 Years

Abstract

- BACKGROUND: Scopinaro-type biliopancreatic diversion (BPD-S) and its variations are the surgeries that offer the best immediate results in weight loss and regain in the late follow-up. It has a high rate of immediate complications and demands control with frequent laboratory tests. AIMS: The aim of this study was to analyze the late postoperative complications of 1570 patients operated by biliopancreatic diversion with gastric preservation laparoscopic video with up to 20 years of postoperative follow-up. METHODS: In a follow-up period of up to 20 years, the clinical and surgical complications of 1570 patients with grade II or III obesity were evaluated who were operated on from 2001 to 2014 with the same team of surgeons. Clavien Dindo 11 classification was used for analysis and comparison. Laboratory tests and body mass index (BMI) were used in the analysis of late metabolic outcomes. RESULTS: On the one hand, complications in 204 patients were recorded (13%), and 143 patients (9.1%) were reoperated. On the other hand, 61 patients (29.9%), who had postoperative complications were clinically treated with good evolution in 9.2 years (95%CI 8.2-10.3), with a median of 9.5 years (95%CI 6.1-12.9). Gastroileal anastomosis ulcers occurred in 44 patients (2.8%). Patients with malnutrition, severe anemia, or chronic diarrhea were operated on with common loop elongation (n=64 - 4%), conversion to gastric diversion (n=29 - 5%), or reversal of surgery (n=10 - 0.6%). One death was registered throughout casuistry (0.06%). CONCLUSIONS: Metabolic result of DBP-S was considered excellent in most patients, even referring to changes in the frequency of bowel movements, loose stools, and unpleasant odor. Complications are usually serious and most of the patients require surgical treatment. Therefore, the biliopancreatic diversion of Scopinaro should be reserved for exceptional cases, as there are safer surgical alternatives with less serious side effects.

Brazilian Multi-Society Position Statement on Emerging Bariatric and Metabolic Surgical Procedures

“…The shortening of the common canal, combined with the potent incretin stimulus, leads to a decrease in the absorption of micronutrients, fat-soluble vitamins, and proteins, and can even cause changes in bowel habits, sometimes with clinical intractability. Due to the imperative need for continuous monitoring and the risk of serious nutritional complications with potentially irreversible consequences, depending on the timing of diagnosis, this procedure has been abandoned 20 , 44 .…”

Degastrectomia Sem Vagotomia Por Úlcera Perfurada De Coto Gástrico E Deiscência Completa De Anastomose Prévia Em Gastrectomia Subtotal Em Y-De-Roux

“…A degastrectomia é a realização de uma nova abordagem e ressecção gástrica em pacientes previamente já submetidos ao procedimento. Ela é normalmente realizada quando existem recidivas locais de tumores ou desenvolvimento de complicações na área da anastomose ou, menos comumente, como tratamento para a recidiva de úlceras (3). Já a vagotomia consiste da secção do nervo vago que, dentre outras funções, exerce um dos estímulos para a produção de secreção ácida em determinadas células do estômago.…”

Degastrectomia Sem Vagotomia Por Úlcera Perfurada De Coto Gástrico E Deiscência Completa De Anastomose Prévia Em Gastrectomia Subtotal Em Y-De-Roux

“…Ela é normalmente feita quando existem recidivas locais de tumores ou desenvolvimento de complicações na área da anastomose ou, menos comumente, como tratamento para a recidiva de úlceras. [1][2][3][4] Já a vagotomia consiste da secção do nervo vago que, dentre outras funções, exerce um dos estímulos para a produção de secreção ácida em determinadas células do estômago. Esse procedimento está condicionado à extensão da ressecção do estômago e a realização de gastrectomias alargadas com ressecção quase total do estômago dispensa a realização de vagotomia por eliminar grande parte da área produtora de secreção ácida.…”