Biliopancreatic diversion: clinical experience.

BACKGROUND: Biliopancreatic diversion (BPD), by ad hoc stomach resection (AHS-BPD) has been accepted as an effective surgical treatment for morbid obesity. METHODS: Between 1.1.1992 and 31.7.1996, 59 patients (54 females, five males, mean age 40.3 years, range 23-61 years) underwent AHS-BPD. Mean preoperative body-weight was 121.2 kg (range 94-160), with a mean body mass index of 48.6 (range 35-64). Three of these patients were converted from a previous vertical banded gastroplasty to AHS-BPD (one patient with stomach preservation). After at least 36 months follow-up, seven patients underwent abdominal dermolipectomy (five with associated incisional hernia repair, one with thigh dermolipectomy). RESULTS: Mean post-operative hospital stay was 13 days (range 10-30 days). Follow-up is currently in progress in all patients. Excess body weight-loss was 78% in 33 patients with 24 months follow-up, with excellent long-term weight loss maintenance. Protein deficiency was the main specific complication, encountered in two patients (3.4%). Mortality was one patient (1.7%), due to pulmonary embolus. CONCLUSIONS: This clinical experience supports the effectiveness and safety of AHS-BPD, despite some criticism. This procedure appears to be suitable for patients with clinically severe obesity who will poorly tolerate food intake restriction but will accept long-term follow-up. Careful preoperative clinical assessment and selection of patients who will be reliable in long-term follow-up are the keys to success with AHS-BPD, both in terms of weight loss and reduction of specific metabolic complications.

[Perioperative treatment with thymostimulin in patients with stomach and colorectal neoplasms. Our experience with 114 cases]. / Trattamento perioperatorio con timostimolina in pazienti affetti da neoplasia dello stomaco e del colon retto. Nostra esperienza su 114 casi.

The authors report their experience about the use of the timostimoline in the perioperative time in 114 cases of gastric and rectum cancer. They think that this method can be of help for neoplastic patients about the time of surgical stress.

[Observations in sclerosing cholangitis]. / Alcune osservazioni sulla colangite sclerosante.

Sclerosing cholangitis is a rare liver disease of unknown etiology with a slow but progressive course. The authors report their experience and illustrate some surgical procedures to preserve bile duct patency in view of a liver transplantation program.