Biliopancreatic Diversion (BPD), Long Common Limb Revisional Biliopancreatic Diversion (BPD + LCL–R), Roux-en-Y Gastric Bypass [RYGB] and Sleeve Gastrectomy (SG) mediate differential quantitative changes in body weight and qualitative modifications in body composition: a 5-year study

Fig. 1. Roux-en-Y gastric bypass (RYGB). A small gastric pouch is created, to which a Roux-en-Y jejunal limb is anastomized. The larger portion of the stomach, excluded from transit of food, is typically left in place in the peritoneal cavity. The alimentary and bibliopancreatic limbs are not designed to establish a malabsorptive condition

Fig. 2. Biliopancreatic diversion with distal gastrectomy according to the original model by Scopinaro (BPD) on the left; long common limb revisional BPD (LCL-R BPD) on the right BPD is a malabsorptive procedure in which, by means of a distal gastrectomy and a long Roux-en-Y gastro-ileostomy, a 250-cm ileal limb is left in continuity and, along this, a 50-cm distal common channel is constructed, where the ingested nutrients could come in contact with biliopancreatic secretions. By diverting biliopancreatic secretions from contact with food along the majority of the small bowel, a condition of selective malabsorption for fat ensues, determining the appearance of a threshold for intestinal absorption of alimentary calories. LCL-R-BPD is graphically presented in close linkage with BPD, owing to direct anatomical and technical connections. From the original model of BPD, an elongationg of the common limb from 50 to 200 cm is performed, at the expense of the alimentary limb. Simultaneously, with the aim of avoiding weight regain, the gastric pouch is reduced from 500 to 40 ml. The resulting procedure consists of a gastric pouch of 40 ml and a total in continuity small bowel limb of 250 cm,…

Fig. 3. Laparoscopic adjustable gastric band (LAGB). A restrictive bariatric procedure, consisting in wrapping the subcardial region of the stomach with a silicone ring, which can be calibrated by injecting or removing fluid (e.g. sterile saline solution) from a connected subcutaneous port, thus regulating the width of the corresponding gastric lumen. In this way, a small upper gastric chamber is created, which empties through a narrow orifice in the remaining of the stomach, restricting the amount of food that could be introduced at a time

Fig. 4. Sleeve gastrectomy (SG). A restrictive bariatric procedure in which the gastric fundus and the majority of the gastric body are removed, leaving in place the pyloric antrum and a narrow gastric tubule with the shape of a sleeve in continuity with the oesophagus. The procedure determines a reduction of the gastric capacity to approximately 15–25% of the starting values

Fig. 5. Body mass index (BMI), fat mass (FM), fat-free mass (FFM) and total body water (TBW) at baseline and at yearly visits up to 5 years in subjects undergoing the four kinds of bariatric surgery. Means ± SE. The red arrow indicates the median time for revisional surgery in subjects undergoing BPD + LCL−R

Fig. 6. Excess body mass loss (%EBL), and change of BMI, FM, FFM at baseline and at yearly visits up to 5 years in subjects undergoing the four kinds of bariatric surgery. Means ± SE

Fig. 7. Changes of %EBL, BMI, FM and FFM observed at 2 years, 5 years, and between 2 and 5 years after the four kinds of bariatric surgery. Means ± SE