Physiologie de l’absorption alimentaire: diversion biliopancréatique. Mise à jour à propos de 3000 interventions

Abstract

A propos of a series of 3,000 procedures, 162 of which were performed laparoscopically, the author presents the advantages and drawbacks of biliopancreatic bypass (DBP). DBP allows an over 70% initial excess weight loss, both in obese and superobese patients ; the weight loss remains constant and above all it is long lasting (25 years). In fact, DBP has a favourable effect on glucose metabolism, with 98% of cases of diabetes cured at 10 years ; it lowers serum cholesterol lastingly and increases HDL cholesterol. DBP also regulates blood pressure in 80% of cases at 10 years. DBP could represent the most powerful treatment against hyperlipidemia and type II diabetes mellitus. Anaemia, bone demineralisation, gastric ulcer and peripheral neuropathy are easily controlled ; the major problem is that of protein malnutrition (MP) both in its early episodic form and recurring form. In "ad hoc DBP " the author tailors the procedure to patient characteristics, namely gastric volume and length of feeding loop. In his last 300 operated patients, his results at 10 years are 1% of recurring MP leading to 1% reoperations, with a 71% permanent loss of initial excess weight.

KEYWORDS: Obesity, Biliopancreatic bypass (DBP), Metabolic syndrome, Type II diabetes, Hyperlipidemia