Emergency surgical conditions after biliopancreatic diversion

Background: Urgent late complications of biliopancreatic diversion (BPD) such as intestinal obstruction, massive hemorrhage and perforation, are rare and often require the experience of a bariatric surgery team for their immediate resolution. Significant anatomical changes in intestinal transit are consequence of BPD and they may cause pain-producing reflexes. Therefore, symptoms of complications may present differently with respect to normal population hence atypical clinical manifestation have to be carefully taken into account. Clinicians should consider abnormal laboratory and radiological pictures and situate these in the context of the intervention of BPD. Methods: The present work analyzes the incidence of emergency surgical conditions in a group of 138 patients who had undergone classical BPD, with a mean follow-up of 60 months (24-96) after BPD. Results: Urgent surgical intervention was necessary in 9 patients out of 138 (6.5%): 7 (5%) were for intestinal obstruction (4 of the biliopancreatic limb and 3 of the alimentary tract); 2 (1.4%) were for stomal ulcer with complications (1 massive hemorrhage and 1 perforation). Conclusions: These complications of BPD are common to all GI operations, and thus are not specific to the type of surgery. We emphasize the importance of early diagnosis and treatment, particularly in regard to intestinal obstruction, because delay could have dramatic consequences.