The bilio-intestinal bypass

Background: Since 1990, we adopted the bilio-intestinal bypass (BIBP) for all morbidly obese patients eligible for a malabsorption procedure. Since 2001 we used laparoscopic technique. Methods: 148 patients, mean age 35.4 (18-63) years; preoper- ative mean weight kg 148.3 (104-225); mean preoperative BMI 54.1 kg/m2 (40-66.2); mean follow-up 10 years (1-22). 83 patients underwent open and 65 laparoscopic BIBP. Laparoscopic BIBP was performed with five lap ports. Section of the jejunum 30 cm distal to the ligament of Treitz and of mesentery was made by a linear stapler. The cholecysto-jejunal anastomosis was completed with 45-mm linear stapler. A side-to-side anastomosis between the proximal jejunum and the last 12-18 cm of the ileum was cre- ated by firing a 60-mm linear stapler. 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 kg/m2 (24-41). Two patients of the 65 laparoscopic patients were converted to open surgery for adhe- sions post-appendectomy. The main late complications were inci- sional hernia (19.3%) and abdominal bloating (2.9%). The rever- sal and conversion rate was 6.5%. There was no death. Conclusions: Our experience showed that 5 years post-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.