COMPLICATIONS AND LATE FOLLOW-UP OF SCOPINARO’S SURGERY WITH GASTRIC PRESERVATION: 1570 PATIENTS OPERATED IN 20 YEARS

VOLPE, Paula; DOMENE, Carlos Eduardo; SANTANA, André Valente; MIRA, William Giglio; SANTO, Marco Aurélio

doi:10.1590/0102-672020210002e1646

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ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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Original Article • ABCD, arq. bras. cir. dig. 35 • 2022 • https://doi.org/10.1590/0102-672020210002e1646 copy

COMPLICATIONS AND LATE FOLLOW-UP OF SCOPINARO’S SURGERY WITH GASTRIC PRESERVATION: 1570 PATIENTS OPERATED IN 20 YEARS

COMPLICAÇÕES E ACOMPANHAMENTO TARDIOS DA CIRURGIA DE SCOPINARO COM PRESERVAÇÃO GÁSTRICA: 1.570 PACIENTES OPERADOS EM 20 ANOS

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT - BACKGROUND:

Scopinaro-type biliopancreatic diversion (BPD-S) and its variations are the surgeries that offer the best immediate results in weight loss and regain in the late follow-up. It has a high rate of immediate complications and demands control with frequent laboratory tests.

AIMS:

The aim of this study was to analyze the late postoperative complications of 1570 patients operated by biliopancreatic diversion with gastric preservation laparoscopic video with up to 20 years of postoperative follow-up.

METHODS:

In a follow-up period of up to 20 years, the clinical and surgical complications of 1570 patients with grade II or III obesity were evaluated who were operated on from 2001 to 2014 with the same team of surgeons. Clavien Dindo 11 classification was used for analysis and comparison. Laboratory tests and body mass index (BMI) were used in the analysis of late metabolic outcomes.

RESULTS:

On the one hand, complications in 204 patients were recorded (13%), and 143 patients (9.1%) were reoperated. On the other hand, 61 patients (29.9%), who had postoperative complications were clinically treated with good evolution in 9.2 years (95%CI 8.2-10.3), with a median of 9.5 years (95%CI 6.1-12.9). Gastroileal anastomosis ulcers occurred in 44 patients (2.8%). Patients with malnutrition, severe anemia, or chronic diarrhea were operated on with common loop elongation (n=64 - 4%), conversion to gastric diversion (n=29 - 5%), or reversal of surgery (n=10 - 0.6%). One death was registered throughout casuistry (0.06%).

CONCLUSIONS:

Metabolic result of DBP-S was considered excellent in most patients, even referring to changes in the frequency of bowel movements, loose stools, and unpleasant odor. Complications are usually serious and most of the patients require surgical treatment. Therefore, the biliopancreatic diversion of Scopinaro should be reserved for exceptional cases, as there are safer surgical alternatives with less serious side effects.

HEADINGS:
Postoperative Complications; Bariatric surgery; Malnutrition; Morbid obesity

Complication	Number	%
Malnutrition	95	46.5
Chronic Diarrhea	58	28.4
Gastroileal Anastomosis Ulcer	44	21.5
Severe Chronic Anemia	42	20.5
Internal Hernia	21	10.3
Acute Pancreatitis	03	0.14
Arthritis	02	0.90
Hepatopaty	02	0.90
Spontaneous Bone Fracture	02	0.90
Pulmonary Tuberculosis	02	0.90
Intestinal Tuberculosis	01	0.50
Idiopathic Septicemia	01	0.50
Intractable Hipocalcemia	01	0.50
Intestinal Obstruction	01	0.50
Total	288

	N	%	95%CI
	N	%	Inferior	Superior
Sex
Male	59	28.9%	23.0%	35.4%
Female	145	71.1%	64.6%	77.0%
Diabetes T0
No	147	72.1%	65.6%	77.9%
Yes	57	27.9%	22.1%	34.4%
Complication Type T1
Clinical	61	29.9%	23.9%	36.4%
Surgical	143	70.1%	63.6%	76.1%
Clavien Dindo T1
II	61	29.9%	23.9%	36.4%
IIIB	143	70.1%	63.6%	76.1%
Treatment T1
Clinical	61	29.9%	23.9%	36.4%
Surgical	143	70.1%	63.6%	76.1%
Evolution T1
Good	188	92.2%	87.9%	95.3%
Regular	14	6.9%	4.0%	10.9%
Death	2	1.0%	0.2%	3.1%
Complications T2
I	1	2.8%	0.3%	12.3%
II	14	38.9%	24.3%	55.2%
IIIB	19	52.8%	36.8%	68.3%
IV	2	5.6%	1.2%	16.6%
Treatment T2
Clinical	12	42.9%	27.6%	59.3%
Surgical	24	57.1%	40.7%	72.4%
Evolution T2
Good	34	94.3%	82.9%	98.8%
Death	2	5.7%	1.2%	17.1%

	Average	SD	Median	P25	P75	Min.	Max.
Age (years)	48.0	10.0	48.0	42.0	54.0	17.0	72.0
Time of disease (years)	4.7	3.3	4.0	2.0	6.0	0.4	20.0
BMI (kg/m²) T0	42.0	5.8	40.8	37.7	44.7	30.1	65.2
A1C (%) T0	7.9	1.5	7.3	6.8	8.4	6.5	14.8
Glycemia (mg/dL) T0	161.0	58.0	140.0	124.0	183.0	102.0	576.0
Other medications (number) T0	1.0	1.0	1.0	1.0	2.0	1.0	4.0
Comorbidities (number) T0	2.0	1.0	1.0	1.0	2.0	1.0	6.0
A1C (%)T1	5.6	0.9	5.5	5.2	6.0	4.0	10.3
Glycemia (mg/dL) T1	96.8	22.9	93.0	87.0	101.5	4.9	189.0
A1C (%) T2	5.0	0.6	5.0	4.6	5.4	3.6	7.2
Glycemia (mg/dL) T2	92.2	16.2	88.0	84.0	96.0	70.0	193.0
BMI (kg/m²) ST	30.7	5.2	29.7	27.5	33.2	19.7	57.1
A1C (%) ST	5.3	0.9	5.2	4.6	5.7	3.5	10.0
Glycemia (mg/dL) ST	95.0	25.7	89.5	85.0	99.0	48.0	317.0
Other medications (number) ST	0.0	1.0	0.0	0.0	0.0	0.0	3.0
Comorbidities ST	1.0	0.0	1.0	1.0	1.0	1.0	2.0

Gastroileal anastomosis ulceration	N	%
No perforation, bleeding, or stenosis	17	08.3
Perforation	17	08.3
High digestive bleeding	07	04.9
Stenosis	03	01.4
Total	44	21.5

Diagnosis	N	%	Treatment	N	%	Evolution
Malnutrition/Anemia	68	33.3	Common Limb Elongation	55	26.9	Good
			Conversion To Bypass	10	04.9	Good
			Reversal	03	01.5	Good
Chronic Diarrhea	32	15.6	Conversion To Bypass	16	07.8	Good
			Common Limb Elongation	09	04.4	Good
			Reversal	07	03.4	Good
Internal Hernia	21	10.3	Mesenteric Closure	21	10.3	Good
GI Anastomosis Ulcer	17	08.3	Suture Of Ulceration	07	03.4	Good
			Degastrectomy	07	03.4	Good
			Conversion To Bypass	03	01.5	Good
Intestinal Obstruction	01	0.49	Enterectomy	01	0.49	Good
Acute Pancreatitis	01	0.49	Distal Pancreatectomy	01	0.49	Death
Spontaneous Fracture	01	0.49	Reversal	01	0.49	Good
Acute Hepatopathy	01	0.49	Reversal	01	0.49	Good
Hipocalcemy	01	0.49	Reversal	01	0.49	Good
Total				143	70.1

Diagnosis	N	%	Evolution
Severe malnutrition	28	13.7	Good
Gastroileal anastomosis ulceration	27	13.2	Good
Severe chronic diarrhea	02	0.98	Good
Septicemy	01	0.49	Good
Spontaneous bone fracture, malnutrition, anemia	01	0.49	Good
Pulmonary tuberculosis, malnutrition, ulcer	01	0.49	Good
Acute hepatic failure	01	0.49	Good
Total	61	29.9

	N	%	Average	95%CI	Median	95%CI
Clinical complication	59	29.9%	9.2	8.2-10.3	9.5	6.1-12.9
Surgical complication	140	70.1%	5.9	5.2-6.6	5.1	3.7-6.5
Ulcer	51	21.5%	10.1	9.1-11.2	11.7	8.9-14.5
Malnutrition	89	43.6%	7.6	6.8-8.5	7.5	6.3-8.8
Internal hernia	22	10.3%	12.4	11.5-13.3	14.3	9.8-18.8

First complication	N	%		N	%
Malnutrition	19	09.3	Associated	11	05.3
Malnutrition	19	09.3	Isolated	08	03.9
GI anastomosis ulcer	11	05.3	Perforation	06	02.9
GI anastomosis ulcer	11	05.3	No perforation	05	02.4
Diarrea				03	01.4
Internal hernia				03	01.4
Total				36	17.6

First complication	N	Treatment	Second complication	N	Treatment	N	Evolution
Diarrhea	3	Common Limb Elongation	Diarrhea	3	Conversion to bypass	3	Good
Internal Hernia	2	Mesenteric Closure	Gastroileal anastomosis ulcer	2	Clinical	2	Good
Internal Hernia	1	Mesenteric Closure	Malnutrition	1	Reversion	1	Good

Second complication	N	Treatment	Evolution
Gastroileal anastomosis ulcer	2	Clinical	Good
Desnutrição	2	Clinical	Good
Internal hernia	1	Enterectomy and mesenteric closure	Good
Total	5

Second complication	N	Treatment	N	Evolution
Perforated ulcer	3	Reversal	1	Good
		Degastrectomy	1	Good
		Ulcer suture	1	Good
Ulcer without perforation	2	Clinical	2	Good
Malnutrition	3	Clinical	2	Good
Malnutrition	3	Reversal	1	Good
Diarrhea	2	Conversion to bypass	2	Good
Internal hernia	1	Mesenteric closure	1	Good
Ulcerative colitis	1	Colectomy and reversal	1	Good
Hepatic failure	1	Clinical	1	Death
Hepatic cirrosis	1	Hepatic transplantation	1	Death
Total	14		14

Treatment of First complication	N	Second complication	Treatment	Evolution
Clinical	1	Upper GI bleeding	Hemostasis	Good
Clinical	1	Malnutrition	Clinical	Good
Clinical	1	Internal hernia	Mesenteric Closure	Good
Degastrectomia	1	Anastomosis ulcer	Clinical	Good
Degastrectomia	1	Malnutrition	Common limb elongation	Good
Total	5

Treatment of First complication	N	Second complication	Treatment	Evolution
Clinical	1	Upper GI bleeding	Hemostasis	Good
Clinical	1	Malnutrition	Clinical	Good
Clinical	1	Internal hernia	Mesenteric Closure	Good
Degastrectomy	1	Anastomosis ulcer	Clinical	Good
Degastrectomy	1	Malnutrition	Common limb elongation	Good
Total	5

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E-mail: revistaabcd@gmail.com

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[1] Correspondência: Paula Volpe. Email: pvolpe@uol.com.br