Complications of the Scopinaro procedure vs. DS

October 24, 2001

Hi Everyone,

I consider it improper to compare complications rates of Dr. Baltasar

to Dr. Scopinaro as a method of determining which procedure is safer.

Rather we should look at Dr. Marceau's report (1998) which compares

252 Scopinaro procedures (BPD/DG) to 465 BPD/DS procedures that he

has done. This way the skill of the surgeon is removed as a variable

and we have a valid comparison (to be fair the DS was done after the

BPD/DG, so it isn't 100% fair, but the best we have):

Operative mortality was 1.6% for BPD/DG and 1.9% for BPD/DS,

statistically the same.

Operative morbidity was 16.7% for BPD/DG and 16.3% for BPD/DS, again

statistically the same.

Delayed mortality was 2.4% for BPD/DG and 1.9% for BPD/DS.

Hence we can conclude that the complications rates for BPD and BPD/DS

are identical IN THE HANDS OF AN EXPERIENCED SURGEON.

What about side effects? This is where the DS is of benifit.

Marceau shows in his most recent paper with 216 BPD/DG patients and

909 BPD/DS patients that th amount of Fatigue, Diarrhea, Bloating,

Bone Pain, Arthalrgia, Peripheral edema, Vomiting, and number of

stools/day were significantly lower (often half) with the BPD/DS.

The only side effect that was worse with the DS was Epigastralgia

(6.7% vs. 5.2%).

Again, the DS procedures were done after the BPD/DG procedures, so we

had an experienced surgeon who was up the learning curve.

Dr. Ren and Dr. are relatively inexperienced with the BPD

procedures. It may be that the BPD/DS has a more difficult learning

curve than BPD (certainly Baltasar's early results attest to this).

In addition, Dr. Marceau did all of his procedures open. I think

that this is a key variable. The BPD/DS may no be a very safe

procedure when done fully laprascopically, but appears to be quite

safe when done open or lap assisted (ala Rabkin).

Hull

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