Repeated operations after pylori-preserving variants of biliopancreatic bypass surgery

Introduction. Currently, biliopancreatic diversion (BPD) as the most effective bariatric surgery for the treatment of morbid obesity and related metabolic disorders is used relatively rarely. Also, there is no consensus about the indications, the timing of revisional operations after BPD.

Aim. General and comparative evaluation of the effectiveness and safety of revisional operations after BPD with sleeve gastrectomy (Hess-Marceau and SADI-s modifications).

Materials and methods. As a part of a prospective study in the period from 2003 to 2023, the results of surgical treatment of 810 patients with morbid obesity were evaluated, 529 of whom underwent BPD/DS, and 281 patients underwent SADI-s. Subsequently, 108 out of 810 patients underwent 116 revisions at different times after surgery. To eliminate side effects, elongations of functioning bowel segments were done. To improve the results of the primary operation – resection / plication of the small stomach, as well as shortening of the common and alimentary loops. In order to treat clinically significant bile reflux after SADI - reconstruction to BPD/DS was performed.

Results. In the BPD/DS group, 8,5 %, in the SADI-s group, 5,7 % of patients underwent revisional operations to improve results, and 8 (7,4 %) patients underwent more than 1 reconstructive surgery. 9 (20 %) reconstructions in the BPD/DS group and 7 (43,8 %) in the SADI-s group were performed simultaneously with abdominoplasty. 9,3 % of patients underwent secondary operations to treat complications and side effects after BPD/DS. In the SADI-s group, the need for restorations occurred much less frequently than in BPD/DS group.

Conclusion. When planning revisional operations, it is necessary to assess the possibility of influencing on both restrictive and hypoabsorptive components by performing preoperative radiopaque examination of the stomach and intraoperative measurement of small intestine segments. Restoration of the excluded small bowel segments allowed in all cases to eliminate the manifestations of complications, but usually led to weight regain, and therefore it is necessary to keep in mind the possibility of further revisions.

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