Abstracts
1998 Digestive Disease Week

#2322

MALABSORPTIVE PROCEDURES FOR SEVERE OBESITY: COMPARISON OF PANCREATICOBILIARY BYPASS (PBB) AND VERY, VERY LONG ROUX-EN-Y GASTRIC BYPASS (VVLGB). MM Murr, BM Balsiger, FP Kennedy, MG Sarr. Dept. of Surgery, Mayo Clinic, Rochester, MN.

AIM: To determine efficacy and safety of two malabsorptive procedures for severe obesity. METHODS: We prospectively collected data on all patients who have undergone bariatric surgery at Mayo Clinic. Eight men and 3 women from 1989-93 underwent PBB (80% gastrectomy, gastroileostomy, and jejunoileostomy with 50-cm common channel). Nineteen men and 7 women from 1993-97 underwent VVLGB (Roux limb~ 300-400 cm, jejunoileostomy with 100-cm common channel). All were counseled in vitamin and mineral supplements. Age (42 ± 3, 40 ± 2 years), body-mass index (BMI: 64 ± 4, 67 ± 3 kg/m2) and % excess body weight (%EBW: 183 ± 17, 203 ± 12%) were similar ( ± SEM). Median follow-up was 80 months (69-99) and 25 months (3-55) for the PBB and VVLGB groups, resp. Weight loss expressed as %EBW was 68 ± 4% 2 years and 71 ± 5% 4 years after PBB. In patients who underwent a VVLGB, weight loss was 57 ± 7, 58 ± 6, and 43 ± 6% at>24 months (n=12), 12-24 months (n=6), and <12 months (n=8) after surgery. RESULTS: Hospital mortality was zero. Median hospital stay was 11 and 8 days for PBB and VVLGB. Morbidity occurred in 5 patients after VVLGB: wound infection (4), wound seroma (1) and pulmonary embolus (1); and in 2 patients after PBB: abscess (2), anastomotic leak (1), and GI bleed (1). After PBB, 1 woman died from refractory liver failure 18 months postop and another developed metabolic bone disease; all had diarrhea, steatorrhea, and very foul smelling stool. After VVLGB, none had liver failure, metabolic problems, or diarrhea. No patient underwent reversal for metabolic or nutritional consequences. All patients have recommended bariatric surgery for others, were satisfied with results, and reported improved subjective quality of life except for the late death after PBB. CONCLUSION: VVLGB is safe and effective for clinically significant obesity, results in sustained weight loss, ameliorates co-morbid conditions, and improves quality of life. Maintaining a 100-cm common channel of distal ileum combined with a small gastric pouch of cardia achieves adequate weight loss without late nutritional or metabolic consequences common to PBB. Based on these data, we have changed our practice and use VVLGB for super-obese patients, patients with severe co-morbid conditions and a BMI of >60, and as a revisional operation for anatomically-intact but failed previous bariatric surgery.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.