Obesity: Scopinaro N

Fried M, Hainer V, Basdevant A, Buchwald H, Dietel M, Finer N, Greve JW, Horber F, Mathus-Vliegen E, Scopinaro N, Steffen R, Tsigos C, Weiner R, Widhalm K. · Klinické centrum pro minimálne invazivní a bariatrickou chirurgii ISCARE a 1. lékarská fakulta Univerzity Karlovy, Praha, Cesko. · Vnitr Lek. · Pubmed #18630623 No free full text.

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Fried M, Hainer V, Basdevant A, Buchwald H, Deitel M, Finer N, Greve JW, Horber F, Mathus-Vliegen E, Scopinaro N, Steffen R, Tsigos C, Weiner R, Widhalm K, Anonymous00354. · Clinical Center for Minimally Invasive and Bariatric Surgery, Prague, Czech Republic. · Obes Surg. · Pubmed #17476884 No free full text.

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Fried M, Hainer V, Basdevant A, Buchwald H, Deitel M, Finer N, Greve JW, Horber F, Mathus-Vliegen E, Scopinaro N, Steffen R, Tsigos C, Weiner R, Widhalm K. · Clinical Center for Minimally Invasive and Bariatric Surgery, 1st Medical Faculty, Charles University, Prague, Czech Republic. · Int J Obes (Lond). · Pubmed #17325689 No free full text.

Abstract: In 2005, for the first time in European history, an extraordinary Expert panel named 'The BSCG' (Bariatric Scientific Collaborative Group), was appointed through joint effort of the major European Scientific Societies which are active in the field of obesity management. Societies that constituted this panel were: IFSO - International Federation for the Surgery of Obesity, IFSO-EC - International Federation for the Surgery of Obesity - European Chapter, EASO - European Association for Study of Obesity, ECOG - European Childhood Obesity Group, together with the IOTF (International Obesity Task Force) which was represented during the completion process by its representative. The BSCG was composed not only of the top officers representing the respective Scientific Societies (four acting presidents, two past presidents, one honorary president, two executive directors), but was balanced with the presence of many other key opinion leaders in the field of obesity. The BSCG composition allowed the coverage of key disciplines in comprehensive obesity management, as well as reflecting European geographical and ethnic diversity. This joint BSCG expert panel convened several meetings which were entirely focused on guidelines creation, during the past two years. There was a specific effort to develop clinical guidelines, which will reflect current knowledge, expertise and evidence based data on morbid obesity treatment.

Buchwald H, Scopinaro N. · No affiliation provided · Obes Surg. · Pubmed #19082674 No free full text.

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Scopinaro N. · No affiliation provided · Ann Ital Chir. · Pubmed #18510023 No free full text.

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Camerini G, Marinari GM, Scopinaro N. · Department of Surgery, University of Genoa School of Medicine, Italy. · Surg Laparosc Endosc Percutan Tech. · Pubmed #12819499 No free full text.

Abstract: A retrocolic submesocolic approach was used for creating the gastroenteroanastomosis in 42 consecutive patients who underwent laparoscopic biliopancreatic diversion for obesity. The surgical technique is described in detail. The laparoscopic gastroenteroanastomosis was successfully performed on all the operated patients, with no intraoperative complications requiring conversion to open surgery and no immediate or late postoperative morbidity related to the anastomosis.

Scopinaro N, Marinari GM, Camerini G. · Department of Surgery, University of Genoa School of Medicine, Genoa, Italy. · Obes Surg. · Pubmed #11975220 No free full text.

Abstract: BACKGROUND: A technique for standard laparoscopic BPD was developed. METHODS: Standard laparoscopic BPD was performed in 26 morbidly obese patients with mean BMI 43. Details of the technique, using 6 trocars, and instrumentation are described. Intestinal limb lengths were measured fully stretched, and the gastric remnant volume was also measured. Both enteroenteral and gastrointestinal anastomoses were fashioned with a side-to-side technique using the endoGIA, the conjoined defect being closed with a manual running seromuscular suture. RESULTS: 6 and 12 month weight loss results were similar to those obtained in open BPD. CONCLUSION: Laparoscopic standard BPD is a feasible alternative to the open operative procedure, the major advantage being the likely near total avoidance of wound hernia.

Briatore L, Salani B, Andraghetti G, Danovaro C, Sferrazzo E, Scopinaro N, Adami GF, Maggi D, Cordera R. · Department of Endocrinology and Medicine, University of Genova, Genova, Italy. · Obesity (Silver Spring). · Pubmed #18223616 No free full text.

Abstract: OBJECTIVE: Biliopancreatic diversion (BPD) restores normal glucose tolerance in a few weeks in morbid obese subjects with type 2 diabetes, improving insulin sensitivity. However, there is less known about the effects of BPD on insulin secretion. We tested the early effects of BPD on insulin secretion in obese subjects with and without type 2 diabetes. METHODS AND PROCEDURES: Twenty-one consecutive morbid obese subjects, 9 with type 2 diabetes (T2DM) and 12 with normal fasting glucose (NFG) were evaluated, just before and 1 month after BPD, by measuring body weight (BW), glucose, adipocitokines, homeostasis model assessment of insulin resistance (HOMA-IR), acute insulin response (AIR) to e.v. glucose and the insulinogenic index adjusted for insulin resistance ([DeltaI5/DeltaG5]/HOMA-IR). RESULTS: Preoperatively, those with T2DM differed from those with NFG in showing higher levels of fasting glucose, reduced AIR (57.9 +/- 29.5 vs. 644.9 +/- 143.1 pmol/l, P < 0.01) and reduced adjusted insulinogenic index (1.0 +/- 0.5 vs. 17.6 +/- 3.9 1/mmol(2), P < 0.001). One month following BPD, in both groups BW was reduced (by approximately 11%), but all subjects were still severely obese; HOMA-IR and leptin decreased significanlty, while high-molecular weight (HMW) adiponectin and adjusted insulinogenic index increased. In the T2DM group, fasting glucose returned to non-diabetic values. AIR did not change in the NFG group, while in the T2DM group it showed a significant increase (from 58.0 +/- 29.5 to 273.8 +/- 47.2 pmol/l, P < 0.01). In the T2DM group, the AIR percentage variation from baseline was significantly related to changes in fasting glucose (r = 0.70, P = 0.02), suggesting an important relationship exists between impaired AIR and hyperglycaemia. DISCUSSION: BPD is able to restore AIR in T2DM even just 1 month after surgery. AIR restoration is associated with normalization of fasting glucose concentrations.

Adami GF, Meneghelli A, Bressani A, Scopinaro N. · Dipartimento di Chirugia, Facoltà di Medicina e Chirurgia, Università di Genova, Italy. · J Psychosom Res. · Pubmed #10193918 No free full text.

Abstract: The role of possessing an abnormal body weight in the body image alterations of obese patients was evaluated in bariatric surgery subjects prior to and at long term after operation, when body weight and shape had become steadily normalized. Body image was assessed by the body dissatisfaction scale of the Eating Disorders Inventory, the Body Shape Questionnaire, and the Body Attitude Questionnaire. When the individuals were obese, a sharply impaired body image was observed; following operation, weight loss corresponded to normalization of body dissatisfaction, feeling of fatness, and physical attractiveness, whereas body disparagement and salience of shape, although improved in comparison to preoperative data, remained significantly different from that of controls. In the obese patients, some aspects of body image alterations are substantially accounted for by overweight status; other aspects reflect inner feelings, which are partially independent of the actual body weight and shape.

Fried M, Hainer V, Basdevant A, Buchwald H, Dietel M, Finer N, Greve JW, Horber F, Mathus-Vliegen E, Scopinaro N, Steffen R, Tsigos C, Weiner R, Widhalm K. · Klinické centrum pro minimálne invazivní a bariatrickou chirurgii ISCARE a Univerzita Karlova--1.lékarská fakulta, Praha, Ceská republika. · Rozhl Chir. · Pubmed #19174948 No free full text.

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Adami GF, Murelli F, Briatore L, Scopinaro N. · Dipartimento di Discipline Chirurgiche, Facoltà di Medicina e Chirurgia, Università di Genova, Genoa, Italy. · Obes Surg. · Pubmed #18478305 No free full text.

Abstract: BACKGROUND: This study describes the pregnancy of previously obese women with type 2 diabetic who reduced body weight and normalized serum glucose level following biliopancreatic diversion (BPD) for obesity. METHODS: A subset of ten women who had type 2 diabetes prior to BPD and who developed pregnancy after the operation was retrospectively identified. RESULTS: All pregnancies were completely normal, and serum glucose levels remained within the physiological range throughout all the pregnancy. These post-diabetic women delivered 13 infants in good health with a normal birth weight and no case of macrosomia. CONCLUSIONS: These data are a clinical confirmation of the post-BPD improvement of beta-cell response to increased functional demand in obese patients with preoperative type 2 diabetes.

Scopinaro N, Papadia F, Camerini G, Marinari G, Civalleri D, Gian Franco A. · Department of Surgery, University of Genoa Medical School-Azienda Ospedaliera, Universitaria San Martino, Largo Rosanna Benzi 8, Genoa, Italy. · Obes Surg. · Pubmed #18463931 No free full text.

Abstract: BACKGROUND: Roux-en-Y gastric bypass (RYGBP) and biliopancreatic diversion (BPD) are highly beneficial operations for type 2 diabetes mellitus (T2DM) in obese patients, leading to complete T2DM resolution in 75-90 and 97-99% of cases, respectively. In both RYGBP and BPD, the foregut is excluded from the food stream and the distal small bowel receives the food stimulation, while following BPD fat intestinal absorption is also extremely limited. This study was carried out to identify clinical features that could give insight on the different mechanisms of action on diabetes resolution. METHODS: The files of 443 severely obese patients with T2DM undergoing BPD from May 1976 to May 2007 were examined, and the presence of T2DM (fasting serum glucose >125 mg/ml) at 1-2 months, at 1 year, at 10 years, and at > or =20 years following the operation was recorded. RESULTS: The percentage of patients cured (fasting serum glucose reduced to < or =110 mg/dl, on free diet and with no therapy) was 74% at 1 month, 97% at 1 and 10 years, and 91% at > or =20 years, the 26% of uncured patients at 1 month being those with most severe preoperative T2DM. CONCLUSIONS: As the early results after BPD resemble those reported after RYGBP, it can be hypothesized that the duodenal exclusion and the distal small bowel stimulation are the first mechanisms acting in BPD, immediately after the operation, that only subsequently the myocellular fat depletion, which cannot be immediate, takes over, and that the minimal fat absorption is the mechanism accounting for the long-term results of BPD.

Ronchi A, Marinari GM, Sukkar SG, Scopinaro N, Adami GF. · Servizio di Nutrizione Clinica, Ospedale San Martino, Genova, Italy. · Behav Med. · Pubmed #18316272 No free full text.

Abstract: The authors' aim in this study was to gain insight on the eating behaviors of severely obese patients seeking bariatric surgery. The authors compared anthropometric and alimentary interview data on 50 patients applying for biliopancreatic diversion with data obtained from 50 severely obese individuals enrolling in a behavior modification weight-loss program. The severely obese patients seeking bariatric surgery were metabolically more compromised than were their counterparts enrolled in the conservative treatment group, whereas the latter more often reported compromised eating behaviors. These unexpected results could reflect changes in the widespread attitudes toward bariatric surgery-that unlike in the past, it is now considered a safe and effective method to treat a serious disease.

Adami GF, Papadia FS, Marinari GM, Camerini GB, Scopinaro N. · Dipartimento di Discipline Chirurgiche e Metodologie Integrate, Facoltà di Medicina e Chirurgia, Università di Genova, Genova, Italy. · Obes Surg. · Pubmed #18172741 No free full text.

Abstract: BACKGROUND: Because of the rearrangement of the gastrointestinal tract, biliopancreatic diversion (BPD) could lead to an increased risk of colorectal cancer caused by possible carcinogenetic action of the unabsorbed food and bile acid on colonic mucosa. METHODS: The incidence of colorectal cancer in 1,898 obese subjects submitted to BPD from May 76 to July 2002 with a minimum follow-up of 5 years was retrospectively evaluated. RESULTS: Among 28,811 person-years, seven cases of colorectal cancer were detected, for an overall incidence of 29.4 per 100,000, which is not different from that observed in the general Italian population, and lower than that reported for obese and type 2 diabetes patients. Logistic regression model suggests that occurrence of colorectal cancer is positively related to the time elapsed from BPD. CONCLUSION: This study indicates that BPD does not carry any increased risk for colorectal cancer. The complete postoperative restoration of insulin sensibility could exert a valuable protective action.

Burguera B, Agusti A, Arner P, Baltasar A, Barbe F, Barcelo A, Breton I, Cabanes T, Casanueva FF, Couce ME, Dieguez C, Fiol M, Fernandez Real JM, Formiguera X, Fruhbeck G, Garcia Romero M, Garcia Sanz M, Ghigo E, Gomis R, Higa K, Ibarra O, Lacy A, Larrad A, Masmiquel L, Moizé V, Moreno B, Moreiro J, Ricart W, Riesco M, Salinas R, Salvador J, Pi-Sunyer FX, Scopinaro N, Sjostrom L, Pagan A, Pereg V, Sánchez Pernaute A, Torres A, Urgeles JR, Vidal-Puig A, Vidal J, Vila M. · Endocrinology Service, Hospital Universitario Son Dureta, Instituto Universitario Ciéncias de la Salud (IUNICS), Mallorca, Spain. · J Endocrinol Invest. · Pubmed #18075287 No free full text.

Abstract: An interdisciplinary panel of specialists met in Mallorca in the first European Symposium on Morbid Obesity entitled; "Morbid Obesity, an Interdisciplinary Approach". During the two and half days of the meeting, the participants discussed several aspects related to pathogenesis, evaluation, and treatment of morbid obesity. The expert panel included basic research scientists, dietitians and nutritionists, exercise physiologists, endocrinologists, psychiatrists, cardiologists, pneumonologists, anesthesiologists, and bariatric surgeons with expertise in the different weight loss surgeries. The symposium was sponsored by the Balearic Islands Health Department; however, this statement is an independent report of the panel and is not a policy statement of any of the sponsors or endorsers of the Symposium. The prevalence of morbid obesity, the most severe state of the disease, has become epidemic. The current recommendations for the therapy of the morbidly obese comes as a result of a National Institutes of Health (NIH) Consensus Conference held in 1991 and subsequently reviewed in 2004 by the American Society for Bariatric Surgery. This document reviews the work-up evaluation of the morbidly obese patient, the current status of the indications for bariatric surgery and which type of procedure should be recommended; it also brings up for discussion some important real-life clinical practice issues, which should be taken into consideration when evaluating and treating morbidly obese patients. Finally, it also goes through current scientific evidence supporting the potential effectiveness of medical therapy as treatment of patients with morbid obesity.

Morino M, Toppino M, Forestieri P, Angrisani L, Allaix ME, Scopinaro N. · Chirurgia Generale II e Centro di Chirurgia Mini Invasiva, Department of Surgery, University of Turin, Turin, Italy. · Ann Surg. · Pubmed #18043102 No free full text.

Abstract: OBJECTIVE: To define mortality rates and risk factors of different bariatric procedures and to identify strategies to reduce the surgical risk in patients undergoing bariatric surgery. SUMMARY BACKGROUND DATA: Postoperative mortality is a rare event after bariatric surgery. Therefore, comprehensive data on mortality are lacking in the literature. METHODS: A retrospective analysis of a large prospective database was carried out. The Italian Society of Obesity Surgery runs a National Registry on bariatric surgery where all procedures performed by members of the Society should be included prospectively. This Registry represents at present the largest database on bariatric surgery worldwide. RESULTS: Between January 1996 and January 2006, 13,871 bariatric surgical procedures were included: 6122 adjustable silicone gastric bandings (ASGB), 4215 vertical banded gastroplasties (VBG), 1106 gastric bypasses, 1988 biliopancreatic diversions (BPD), 303 biliointestinal bypasses, and 137 various procedures. Sixty day mortality was 0.25%. The type of surgical procedure significantly influenced (P < 0.001) mortality risk: 0.1% ASGB, 0.15% VBG, 0.54% gastric bypasses, 0.8% BPD. Pulmonary embolism represented the most common cause of death (38.2%) and was significantly higher in the BPD group (0.4% vs. 0.07% VBG and 0.03% ASGB). Other causes of mortality were the following: cardiac failure 17.6%, intestinal leak 17.6%, respiratory failure 11.8%, and 1 case each of acute pancreatitis, cerebral ischemia, bleeding gastric ulcer, intestinal ischemia, and internal hernia. Therefore, 29.4% of patients died as a result of a direct technical complication of the procedure. Additional significant risk factors included open surgery (P < 0.001), prolonged operative time (P < 0.05), preoperative hypertension (P < 0.01) or diabetes (P < 0.05), and case load per Center (P < 0.01). CONCLUSIONS: Mortality after bariatric surgery is a rare event. It is influenced by different risk factors including type of surgery, open surgery, prolonged operative time, comorbidities, and volume of activity. In defining the best bariatric procedure for each patient the different mortality risks should be taken into account. Choice of the procedure, prevention, early diagnosis, and therapy for cardiovascular complications may reduce postoperative mortality.

Bezante GP, Scopinaro A, Papadia F, Campostano A, Camerini G, Marinari G, Balbi M, Adami GF, Barsotti A, Scopinaro N. · Cardiology Unit, Department of Internal Medicine, University of Genoa, Viale Benedetto XV/6, 16132 Genova, Italy. · Obesity (Silver Spring). · Pubmed #17557982 No free full text.

Abstract: OBJECTIVES: The objectives were to evaluate QT interval (QTc) and QT-interval dispersion (QTd) in severely obese individuals and to determine the effects of biliopancreatic diversion (BPD) and weight loss after BPD on ventricular repolarization parameters. Background: People with severe obesity (SO) have a 50% to 100% increased risk of death associated with a 1.6-fold increased risk of sudden death. BPD surgery induces rapid and considerable weight loss through severe lipid malabsorption, thus achieving long-term weight control. RESEARCH METHODS AND PROCEDURES: A total of 85 subjects with SO (age, 42 +/- 12 years; 66 females; mean body weight, 120 +/- 29 kg; BMI, 45 +/- 11 kg/m(2)) of 330 who had a bariatric surgical consultation between January 2001 and July 2002 were enrolled. Inclusion criteria were sinus rhythm, unremarkable 12 leads surface electrocardiogram, no atrioventricular blocks and/or bundle branch blocks, normal serum electrolyte profile, and no medical therapies exerting known effects on QTc. Exclusion criteria were previous diagnosis of coronary artery disease, known cardiovascular disease, atrial fibrillation or any other known cardiac arrhythmias, cancer, or renal dysfunction. RESULTS: A total of 86% of patients had QTc >440 ms and/or QTd >60 ms. Subjects with SO showed a mean maximum QTc of 446 +/- 28 ms and a mean QTd of 52 +/- 20 ms. A close correlation was found between QTc and QTd (p < 0.0001; R(2) = 0.33). One month after BPD, mean QTc was 420 ms and remained stable at follow-up; QTd was 32 ms at 1 and 6 months and became 35 ms at 1 year. CONCLUSIONS: Ventricular repolarization abnormalities are significantly increased in subjects with SO. Reduction of QT abnormalities after BPD is independent of weight loss and is caused by the 100% reduction of glucose plasma shortly after surgery. This effect may be related to surgical interruption of the entero-insular axis.

Scopinaro N. · · Obes Surg. · Pubmed #17476874 No free full text.

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Scopinaro N, Papadia F, Marinari G, Camerini G, Adami G. · University of Genoa Medical School, Azienda Ospedaliera Universitaria San Martino, Department of Surgery, Genoa, Italy. · Obes Surg. · Pubmed #17476869 No free full text.

Abstract: BACKGROUND: Bariatric operations are the most powerful means of curing type 2 diabetes mellitus (T2D) and the other major components of the metabolic syndrome. Despite the very frequent occurrence of metabolic disturbances in patients with BMI from 30 to 35, there is a general reluctance to operate on these patients, as their disease is considered less severe. METHODS: 7 T2D obese patients with mean BMI < 35 underwent BPD between 1976 and 1996 at the Azienda Ospedaliera Universitaria San Martino of Genoa, Italy. Mean age was 49 years, mean body weight 91 kg, and mean waist circumference 115 (M) and 98 (F) cm. The mean follow-up was 13 (10-18) years. All 7 patients had abnormally high values of serum triglyceride, serum cholesterol, and arterial pressure. RESULTS: In all patients, serum glucose was normalized at 1,2, and 3 years. In 5 patients, a slight increase of serum glucose above 125 mg/dl was observed at or around 5 years, the values being maintained at all subsequent times, with no one value higher than 160 mg ever being recorded. The other 2 patients showed full resolution of diabetes at all follow-up times. Both serum cholesterol and triglyceride values fell to normal 1 year after BPD, and remained within the normal range in all 7 patients during the entire follow-up observation. Arterial pressure normalized in 6 cases and was improved in 1 case. No patient had excessive weight loss at any postoperative time. CONCLUSIONS: T2D patients with BMI < 35 have very severe metabolic disturbances. Surgical therapy for these patients is warranted, and it should be performed as soon as possible, before the rapid evolution of the pattern leads them to a point where even the most effective metabolic surgery operation could be insufficient to yield complete and permanent control of their diabetes.

Papadia FS, Adami GF, Marinari GM, Camerini G, Scopinaro N. · Department of Surgery, University of Genoa School of Medicine, Genoa, Italy. · Surg Obes Relat Dis. · Pubmed #17400517 No free full text.

Abstract: BACKGROUND: The benefits of bariatric surgery in adult obese patients are well known, but data are lacking regarding the outcome of the surgery in adolescents. The aim of this study was to retrospectively assess the operative morbidity and mortality, percentage of loss of initial excess weight, and the incidence of long-term complications and reoperations in a cohort of obese patients who underwent biliopancreatic diversion (BPD) before their 18th birthday. METHODS: A total of 76 adolescent subjects underwent BPD between 1976 and 2005. Of these 78 patients, 7 had Prader-Willi syndrome and 1 had Turner syndrome and were excluded from the study. RESULTS: The patient population comprised 52 girls and 16 boys. Their mean age was 16.8 years, mean body weight at operation was 125 kg (mean body mass index 46 kg/m2). Operative mortality was nil. The mean follow-up was 11 years (range 2-23). The mean percentage of loss of initial excess weight at each patient's longest follow-up was 78%. Before surgery, 33 patients were hypertensive (49%), 11 were dyslipidemic (16%), 3 were hyperglycemic, and 2 had type 2 diabetes. At the longest follow-up period after surgery, only 6 patients were hypertensive, and none were dyslipidemic or diabetic. A total of 19 reoperations were performed in 14 patients (20%), including 7 revisions. Eleven patients developed protein malnutrition 1-10 years after BPD. The long-term mortality rate was 4%. At 4 to 23 years after BPD, 18 of the women had given birth to 28 healthy babies. Three women had had a complicated pregnancy. CONCLUSION: Adolescents can undergo malabsorptive bariatric surgery with excellent long-term weight loss results and an incidence of long-term complications similar to that observed during the 30-year evolution of BPD in our experience.

Marinari GM, Papadia FS, Briatore L, Adami G, Scopinaro N. · Dipartimento di Discipline Chirurgiche, Facoltà di Medicina e Chirurgia, Università di Genova, Genova, Italy. · Obes Surg. · Pubmed #17132408 No free full text.

Abstract: BACKGROUND: The authors investigated the weight loss and maintenance in type 2 diabetic obese patients undergoing biliopancreatic diversion (BPD). METHODS: Two series of diabetic and non-diabetic obese patients matched for gender, age and baseline body mass index (BMI) were evaluated prior to BPD, on the occasion of the regular follow-up visit at 1, 2 and 3 years following the operation, and at the fifth postoperative year. At each follow-up point, body weight (BW), BMI, and serum glucose concentration were measured. RESULTS: In all type 2 diabetic patients, the serum glucose level fell to within the normal range at the first postoperative year and remained within normal limits without any medication throughout all the follow-up period. In preoperatively diabetic subjects, mean values of BW and BMI were closely similar to those of non-diabetic subjects at all follow-up points, and the stabilization weight was independently related to age and to initial BW values. CONCLUSIONS: In obese patients with type 2 diabetes, the glucose level steadily normalized in every case following BPD, and values remained unchanged throughout the follow-up period. After the operation, the type 2 diabetic obese patients experienced the same stable weight reduction as their non-diabetic counterparts.

Pretolesi F, Camerini G, Carlini F, Scopinaro N, Derchi LE. · Radiologia, DICMI, Università di Genova, Largo R. Benzi 8, I-16132 Genoa, Italy. · Radiol Med. · Pubmed #17021693 No free full text.

Abstract: PURPOSE: Diverticula of the proximal gastric pouch are rare after vertical-banded gastroplasty (VBG) for morbid obesity. We report the radiographic findings observed in a series of 12 patients with pouch diverticula. MATERIALS AND METHODS: Lesions were found along the posteromedial wall of the proximal gastric pouch and ranged in size from 10 to 25 mm. Only two patients were symptomatic at the time of diagnosis; in most cases, diverticula were discovered during studies performed as part of the standard follow-up protocol. Diverticula were followed up in 7/12 cases, and four showed slight enlargement over a period ranging from 14 to 53 months. RESULTS: The presence of diverticula was not correlated with symptoms, postoperative weight loss, or clinical history, and no differences in long-term complications were demonstrated between VBG patients with diverticula and those without them. CONCLUSIONS: We do not believe these lesions to be clinically important; at present, our patients are no longer followed up for this problem and undergo diagnostic examinations only if and when they develop symptoms.

Scopinaro N, Marinari G, Camerini G, Papadia F, Anonymous00196. · Department of Surgery, University of Genoa Medical School, Genoa, Italy. · Surg Obes Relat Dis. · Pubmed #16925242 No free full text.

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Adami GF, Parodi RC, Papadia F, Marinari G, Camerini G, Corvisieri R, Scopinaro N. · Dipartimento di Discipline Chirurgiche, Università di Genova, Genova, Italy. · Obes Surg. · Pubmed #16259877 No free full text.

Abstract: BACKGROUND: Intramyocellular content of lipid (IMCL) appears to be important in the pathogenesis of insulin resistance, and the improvement of insulin activity observed following biliopancreatic diversion (BPD) for obesity has to be related to reduction of IMCL. This study evaluates the possibility of detecting changes after BPD in IMCL by means of H1 magnetic resonance spectroscopy. METHODS: The investigation was carried out in obese patients undergoing BPD prior to and at 1 month following the operation. Insulin sensitivity was assessed according to the homeostatic model of assessment (HOMA), and IMCL was determined by the spectroscopy of the tibialis anterior muscle. RESULTS: At 1 month following BPD, an improvement in insulin action was observed in all subjects, and in nearly all cases the IMCL signal decreased. CONCLUSION: The data from this study indicate that magnetic resonance spectroscopy can detect IMCL changes following BPD and is fully suitable for longitudinal studies on muscle metabolic status.

Scopinaro N, Marinari GM, Camerini GB, Papadia FS, Adami GF. · Department of Surgery, University of Genoa School of Medicine, Italy. · Diabetes Care. · Pubmed #16186271 links to  free full text

Abstract: OBJECTIVE: Gastric bypass and biliopancreatic diversion (BPD) are known to have a beneficial effect on glucose metabolism superior to that of the other bariatric operations. Thanks to its excellent weight loss results and to its specific actions, BPD has proven able to guarantee permanent normalization of serum glucose, triglyceride, and cholesterol levels in the vast majority, if not the totality, of operated patients. However, clinical studies on the duration of these effects in large patient populations are still lacking. RESEARCH DESIGN AND METHODS: The files of 312 BPD obese patients with type 2 diabetes operated on from June 1984 to January 1993 were examined. Pre- and postoperative serum glucose, triglyceride, and cholesterol levels, along with arterial pressure measurements, were considered. RESULTS: After BPD, fasting serum glucose concentration fell within normal values in all but two of the operated subjects and remained in the physiological range in all but six up until 10 years. Serum triglyceride and total cholesterol steadily normalized in all subjects with abnormally high preoperative values, and arterial hypertension disappeared in the vast majority of the preoperatively hypertensive patients. CONCLUSIONS: BPD proved able to reverse all the major components of the metabolic syndrome in nearly all the operated subjects, with results being strictly maintained over a 10-year follow-up period. This outcome, which far exceeds those following similar weight loss at short or long term obtained by any other means, confirms the existence of specific actions of BPD on the major components of metabolic syndrome.