Biliopancreatic diversion with pylorus-preserving technique: a new method for the surgical control of hypercholesterolaemia and diabetes II?

OBJECTIVE: The aim of this study was to evaluate the efficacy of biliopancreatic diversion by Scopinaro's method, with a pylorus-preserving modification, in correcting hypercholesterolaemia and diabetes II not controllable by diet or medical treatment. DESIGN: Besides weight loss, Scopinaro's operation produces a correction of hypercholesterolaemia and diabetes. These results encouraged us to perform BPD without gastric resection, thus preserving the functions of the stomach and pylorus in moderately overweight patients with hypercholesterolaemia and diabetes. SETTING AND PATIENTS: The pylorus-preserving technique has been performed on two patients suffering from severe hypercholesterolaemia and hyperglycaemia and who were not more than 30% overweight, at Clinica Chirurgica and Chirurgia d'Urgenza Department, University of Sassari, Italy. Both patients had a six-month follow-up assessment. MAIN OUTCOME MEASURES. Examination of cholesterol and glycaemia levels after the operation, and the moderate weight loss. INTERVENTION: The operation is the same as Scopinaro's with regard to the length of intestine forming the alimentary loop and the common tract. The difference lies in the fact that instead of resecting the stomach and creating a gastroileostomy, we resect the duodenum, and perform a duodenoileostomy. RESULTS. In both patients the cholesterol and glycaemia levels had returned to normal 1 month after the operation and are stable after six months. Weight loss was only moderate. CONCLUSION: By the preliminary data on two patients treated with our modified technique this method seems to be as effective in controlling lipidic metabolism and diabetes II as the original version of biliopancreatic diversion.