Laparoscopic biliopancreatic diversion: technical aspects and results of our protocol.

Background: Biliopancreatic diversion (BPD) has been an excellent operation for morbid obesity to achieve long-term weight reduction. We present our laparoscopic BPD protocol, which includes laparoscopic BPD with or without gastrectomy.

Methods: Our two interventions are: 1) BPD (Scopinaro) by laparoscopy in patients with findings on gastroscopy; 2) BPD by laparoscopy with proximal gastric division without resection in patients without findings on gastroscopy. Since October 2000, we performed 65 laparoscopic BPDs (45 women, 20 men).

Results: 4 cases were converted to open surgery, 3 in the first 10 cases. The average operating-time was 176 minutes (360-110). We detected 2 stenoses of the gastric anastomosis. 2 patients had to be re-operated during the immediate postoperative period because of a leak from the jejuno-ileal anastomosis and a hemoperitoneum.

Conclusion: BPD can be performed satisfactorily by laparoscopy. Avoiding the gastrectomy is an interesting option to reduce technical difficulties, the surgeon's stress, duration of the operation, the patient's stress, and, probably, postoperative morbidity and mortality. We consider an upper digestive endoscopy to be mandatory to determine, before operating, if the patient will need a gastrectomy, depending on its results.