Outcomes of Biliointestinal Bypass among Iranian Obese Patients

Abstract

Background There are several surgical approaches to treat obesity not cured with medical approaches. Each method has its advantages and complications. In here, we have conducted a study to evaluate complications of biliointestinal bypass surgery (BIBP).

Methods A prospective study was conducted in a private hospital from 2002 to 2016. Those patients, not previously operated for morbid obesity, were eligible. Mean follow-up period was 89 months ( ± 54 months; range: 73–108 months). Main outcome measures were weight, BMI (body mass index), concentrations of blood lipids and glucose, liver transaminases, and obesity-related comorbidities and complications.

Results Twenty-three consecutive patients with morbid obesity, including 16 women (69.7%) and seven men (31.3%) with mean age 38.47 ± 10 years (range: 26–57 years) underwent surgery. At the end of follow-up period, a mean BMI reduction of 12.2 kg/m² kg/m² (p < 0.001)] was observed. An excess weight loss (EWL) of 63% ( ± 34) was achieved at the end of the study. Additionally, total cholesterol and triglyceride levels decreased postoperative significantly. The main long-term complications were flatulence (60%), borborygmus (47.8%), mal odorous stool (30.4%), and diarrhea (21.7%). Revision rate was 4.34%. There were no cases with irreversible hepatic injury, deaths due to the surgery, or progressive renal failure.

Conclusion BIBP seems to be a safe, easily reversible, and one of valid therapeutic approaches in morbidly obese patients. BIBP has the potential to achieve durable weight loss and offers an improved quality of life.

Keywords

obesity - BIBP - efficacy - outcome

• References

• 1 Segula D, Frosch AP, SanJoaquin M. , et al. Prevalence and spectrum of illness among hospitalized adults with malaria in Blantyre, Malawi. Malar J 2014; 13: 391
• 2 Ryan DH, Yockey SR. Weight loss and improvement in comorbidity: differences at 5%, 10%, 15%, and over. CurrObes Rep 2017; 6 (02) 187-194
• 3 Valera-Mora ME, Simeoni B, Gagliardi L. , et al. Predictors of weight loss and reversal of comorbidities in malabsorptive bariatric surgery. Am J ClinNutr 2005; 81 (06) 1292-1297
• 4 Lubrano C, Mariani S, Badiali M. , et al. Metabolic or bariatric surgery? Long-term effects of malabsorptivevs restrictive bariatric techniques on body composition and cardiometabolic risk factors. Int J Obes 2010; 34 (09) 1404-1414
• 5 Gagnon LE, KarwackiSheff EJ. Outcomes and complications after bariatric surgery. Am J Nurs 2012; 112 (09) 26-36 , quiz 51, 37
• 6 Gracia JA, Martínez M, Elia M. , et al. Obesity surgery results depending on technique performed: long-term outcome. ObesSurg 2009; 19 (04) 432-438
• 7 Micheletto G, Mozzi E, Lattuada E. , et al. The bilio-intestinal bypass. Ann ItalChir 2007; 78 (01) 27-30
• 8 Gastrointestinal surgery for severe obesity–National Institutes of Health. Consensus Development Conference statement. 1991 ;9 (1):1–20; available from: https://consensus.nih.gov/1991/1991gisurgeryobesity084html.htm ; accessed on September 21 2018
• 9 Sgambato D, Cotticelli G, de Sio I. , et al. Liver failure in an obese middle-aged woman after biliointestinal bypass. World J Clin Cases 2013; 1 (01) 52-55
• 10 Micheletto G, Badiali M, Danelli PG, Sacco R, Sala B, Doldi SB. [The biliointestinal bypass: a thirty-years experience]. Ann ItalChir 2008; 79 (06) 419-426
• 11 Andersen T, Stokholm KH, Backer OG, Quaade F. Long-term (5-year) results after either horizontal gastroplasty or very-low-calorie diet for morbid obesity. Int J Obes 1988; 12 (04) 277-284
• 12 James PT, Rigby N, Leach R. ; International Obesity Task Force. The obesity epidemic, metabolic syndrome and future prevention strategies. Eur J CardiovascPrevRehabil 2004; 11 (01) 3-8
• 13 Dixon JB. Obesity and diabetes: the impact of bariatric surgery on type-2 diabetes. World J Surg 2009; 33 (10) 2014-2021
• 14 Schauer PR, Burguera B, Ikramuddin S. , et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg 2003; 238 (04) 467-484 , discussion 84–85
• 15 Mason EE. Development and future of gastroplasties for morbid obesity. Arch Surg 2003; 138 (04) 361-366
• 16 Lubrano C, Cornoldi A, Pili M. , et al. Reduction of risk factors for cardiovascular diseases in morbid-obese patients following biliary-intestinal bypass: 3 years' follow-up. Int J ObesRelatMetabDisord 2004; 28 (12) 1600-1606
• 17 Colquitt JL, Picot J, Loveman E, Clegg AJ. Surgery for obesity. Cochrane Database Syst Rev 2009; (02) CD003641
• 18 Ellner SJ, Myers TT, Piorkowski JR, Mavanur AA, Barba CA. Routine cholecystectomy is not mandatory during morbid obesity surgery. SurgObesRelat Dis 2007; 3 (04) 456-460
• 19 Hooper MM, Stellato TA, Hallowell PT, Seitz BA, Moskowitz RW. Musculoskeletal findings in obese subjects before and after weight loss following bariatric surgery. Int J Obes 2007; 31 (01) 114-120
• 20 Melissas J, Kontakis G, Volakakis E, Tsepetis T, Alegakis A, Hadjipavlou A. The effect of surgical weight reduction on functional status in morbidly obese patients with low back pain. ObesSurg 2005; 15 (03) 378-381
• 21 Sarwer DB, Wadden TA, Fabricatore AN. Psychosocial and behavioral aspects of bariatric surgery. Obes Res 2005; 13 (04) 639-648
• 22 Simon GE, Rohde P, Ludman EJ. , et al. Association between change in depression and change in weight among women enrolled in weight loss treatment. Gen Hosp Psychiatry 2010; 32 (06) 583-589