Case Report: Transit bipartition: early postoperative food tolerance and bowel function

We report a case demonstrating excellent food tolerance and preserved intestinal function 30 days after transit bipartition, following implementation of an early, structured, and differentiated postoperative nutritional protocol.

A 65-year-old Caucasian woman with a body mass index (BMI) of 57.7 kg/m² presented with a long-standing history of obesity beginning in childhood, a positive family history, and symptom exacerbation during her first of two pregnancies. Comorbidities included functional thrombocytopenia (von Willebrand disease related to factor X deficiency), depression, anxiety, obstructive sleep apnea syndrome (OSAS) requiring continuous positive airway pressure (CPAP) therapy, degenerative osteoarticular disease, and dyslipidemia. Eating behavior assessment revealed emotional eating, binge eating disorder, and volume eating. Dietary intake was characterized by excessive consumption of carbohydrates and sweets (particularly bread), with insufficient intake of fruits, vegetables, and dairy products. The patient underwent laparoscopic transit bipartition, with construction of a 250 cm common limb and a 50 cm ileal bridge. Postoperative nutritional management adhered to enhanced recovery after surgery for bariatric surgery (ERAS-BS) principles. Dietary progression was structured according to the International Dysphagia Diet Standardization Initiative (IDDSI) framework. Food tolerance was evaluated using the validated food quality and tolerance questionnaire proposed by Suter et al, and bowel function was assessed using the Bristol Stool Scale.

Thirty days after surgery, the patient demonstrated excellent alimentary tolerance, achieving a score of 21 on the Suter questionnaire. She reported no nausea, vomiting, or other gastrointestinal symptoms. Stool consistency corresponded to types 3-4 on the Bristol Stool Scale, indicating normal bowel function. The prescribed protein supplementation target of 25 g/day was achieved and well tolerated. During this period, the patient experienced a total weight reduction of 12.2 kg (6.4 kg of fat mass) accompanied by decreases of 5 cm and 8 cm in neck and abdominal circumference, respectively.

The proposed nutritional protocol-characterized by early dietary introduction, structured weekly progression in food consistency, and systematic protein, vitamin, and mineral supplementation-proved to be safe and effective. This approach facilitated excellent food tolerance and normal intestinal function, with no gastrointestinal adverse effects observed during the early postoperative period following transit bipartition.