Short-, mid- and long-term results of Larrad biliopancreatic diversion

Abstract

Background: In an effort to reduce the complications of Scopinaro's biliopancreatic diversion (BPD), in 1989 we introduced the modification of lengthening the alimentary channel preserving most of the jejunum-ileum, by creating a short biliopancreatic limb (50 cm) and maintaining 50 cm of common limb (Larrad 50-50 BPD).

Methods: Of 343 patients who consecutively underwent Larrad 50-50 BPD surgery, 325, 194 and 65 patients were evaluated at 2, 5 and 10 years after surgery, respectively, in terms of surgical morbidity, mortality, metabolic sequelae and weight. Mean age was 41.2 years (range 17-62), mean initial weight 151.2 kg (range 97-260), and BMI was 52.2 kg/m2. Maximum follow-up was 120 months.

Results: Mortality was 0.87% and surgical morbidity 7.6%. There were no cases of suture dehiscence, peritonitis or stomal stenosis. Percent excess weight loss (%EWL) stabilized 2 years after surgery and at 10 years was 77.8 +/- 11.2% for morbidly obese patients and 63.2 +/- 11.8% for super-obese patients. The main complications were 43.8% clinical incisional hernia, 2.5% severe diarrhea, 10.8% mild diarrhea and 9.2% constipation. 30% experienced anemia and/or iron deficiency, and 3% required iron parenterally or lifelong zinc supplements. 28% showed preoperative PTH elevation and 30% vitamin D deficiency; these values postoperatively increased to 45% and 43% respectively. Both these alterations were resolved using supplements, although 12% needed increased doses of vitamin D. The incidence of severe hypoproteinemia was 0.29%. No patient required surgical reversal. When independently evaluated, failure rates in terms of insufficient weight loss were 9% at 5 years and 11.3% at 10 years for morbidly obese, and 12.2% and 14% for super-obese patients respectively. According to the BAROS questionnaire, 75% of surgery outcomes were excellent or very good, 18% good, 5% fair and 2% failures.

Conclusions: After 2, 5 and 10 years, Larrad's BPD has offered excellent results in terms of weight loss and quality of life, a low rate of metabolic sequelae, including a hypoproteinemia rate < 0.5%, and a revision surgery rate 0%.