Derivación biliopancreática en el tratamiento quirúrgico de la obesidad mórbida. Consecuencias metabólicas a largo plazo

Laburpena

Introduction Bariatric surgery is currently the treatment of choice for patients with morbid obesity. Despite this, the election procedure is not clearly established. This doctoral thesis project describes the clinical and metabolic results in patients with obesity undergoing biliopancreatic diversion (DBP) according to the Scopinaro’s technique in a study period of 15 years (1999-2015) with 10-year clinical follow-up. Content of the investigation We have studied retrospectively from a database collected prospectively 277 patients undergoing bariatric surgery using the Scopinaro technique. The average follow-up was 80.8% at 5 years and 57% at 10 years. In this study, the biliopancreatic diversion shows an overall incidence of medical-surgical complications of 20.2%, of which 14.4% have been surgical complications, classified as mild according to Clavien Dindo. DBP has been shown effective in weight loss. The percentage of overweight lost (PSP) was 65.5%, moving from a preoperative body mass index (BMI) of 52% to a postoperative mean BMI of 34.9 kg / m2 after ten years of surgery. The percentage of PSP has been maximum in the first year and has remained stable throughout the follow-up. No significant differences were observed in the weight-related results or in the postoperative surgical complications among the group of patients operated on by open surgery or by laparoscopic surgery. A resolution or improvement of diabetes has been observed in 85.38%, of arterial hypertension in 65.61%, of the obstructive sleep apnoea syndrome in 89.14% and an improvement of lipid alterations. Metabolic changes have occurred despite supplementation. Protein malnutrition has been increasing throughout the monitoring of the sample. It has increased from 1.8% after the first year of surgery to 4.5% at ten years postoperatively. Iron deficiency anaemia is another complication that has developed in the postoperative period of this technique. Vitamin D decreases over time presenting a corresponding increase in PTH to maintain normal calcium metabolism. Most patients report an excellent or very good degree of satisfaction, without significant changes throughout the different evaluations during follow-up. Conclusion The DBP according to the Scopinaro technique has a low morbidity, achieves a significant weight loss and the resolution of a large part of the comorbidities. All this is obtained with a relatively low incidence of morbidity and the results are maintained after 10 years of follow-up.