BILIOINTESTINAL BYPASS: OPEN AND LAPARO- SCOPIC APPROACH

Background: After 1979 when D. Hallberg popularized biliointestinal bypass (BIBP), we used this procedure for 10 years only in morbidly obese patients with previous hepatic disease. Since 1990 we have adopted definitively BIBP for all patients who could be appropriately treated with a malabsorptive procedure. Methods: 92 patients, mean age 37.2 (19-54) years, mean weight 145.7 (105-225) kg, mean BMI 49.2 (40-66.2) kg/m2, mean follow-up 9 (1-22) years. 82 patients underwent open BIBP and 10 from March 2001 have been operated on by the laparo- scopic approach. The operation was performed with five lap ports. Section of the jejunum 30 cm from the Treitz’ ligament and of mesentery was made by linear stapler. The cholecysto-jejunal anastomosis was completed with a 45-mm linear stapler. A side- to-side anastomosis between the proximal jejunum and the last 15-18 cm of the ileum was created by firing a 60-mm linear sta- pler. On the excluded ileum, an anti-reflux valve system was hand-sutured. Results: 5 years postoperatively, mean weight was 89 (62-130) kg, mean BMI was 31 (24-41) kg/m2. No one of the laparoscopic patients was converted to open surgery. The reversal and con- version rate was 7%. The main late complications were incisional hernia (22.3%) and abdominal bloating (17.6%). There was no death. Conclusion: Our experience showed that 5 years after BIBP, the weight loss was satisfactory in 90.7% of patients. Using laparoscopic technique it is possible to reduce pain, in-hospital time, respiratory and thromboembolic complications, convales- cence and incisional hernia.