Dr. Elariny on BPD vs DS plus pylorus and related surgical techniques

December 10, 2001

In October we also had a thread about Drs. Ren and

expressing hesitancy about doing the DS as well as pyloric valve

issues. I showed some of the posts to Dr. Elariny. Here is his

reply (by permission):

At 12:28 AM -0500 10/29/01, Hazem A. Elariny wrote:

>

>Very interesting Steve!

>

>I have also had a discussion with another surgeon who stopped doing the DS

>in favor of the Scopinaro operation. He also quoted a higher leak rate and

>pancreatitis rate and had one patient who died as a result of pancreatitis.

>I have had one case of mild pancreatitis, no deaths, and since I have

>started hand-sewing the duodeno-ileal anastamosis (probably the last 50

>cases), I have not had a single leak. I think alot of surgeons' problems

>come from two things done during Lap-DS surgery. 1) stapled duodeno-ileal

>anastamosis; 2) devascularizing the pylorus to get the duodenal stump

>disected. If you devascularize the pylorus, and totally detatch it from its

>surrounding structures, then you are asking alot to expect it to continue to

>function. Another thing is the extent of gastrectomy performed adjacent to

>the pylorus and adjacent to the esophagus. The closer you go to these

>structures, the more likely they are to affect the gastric emptying. We

>avoid doing any of these things. In any case, the Scopinaro procedure is

>still a good operation, but it does increase the risk of B12 and Iron

>deficiency compared to the DS, and there may be a higher stomal ulcer rate.

>

>Of course, I do either, so I have no personal bias toward one or the other.

>

>Sincerely,

>

>Hazem A. Elariny, MD, PhD, FACS

>Advanced Laparoscopic and General Surgery Associates, PLLC

>1635 N Mason Dr.

>Suite 455

>Arlington, VA 22205

>

> (Fax)

>helariny@...

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