Malabsorptive Surgery
Biliopancreatic Diversion

Biliopancreatic diversion (BPD), originally developed by Dr. Scopinaro in Italy, employs a malabsorptive technique.  This extensive gastric bypass operation was once a commonly performed procedure; however, today it is not widely used due to the risk of nutritional deficiencies.

General Procedure

BPD interrupts the normal process of digestion by removing 2/3 of the stomach.  The small pouch that remains bypasses the duodenum and jejunum and is connected to the lower portion of the small intestine.  By reducing the size of the stomach to create a quicker sense of fullness, an individual can eat less and thus consume fewer calories.  Less food and less calories result in achieving fast weight loss.  For this reason, BPD was once an excellent way to achieve weight loss for a severely obese individual.

BPD can be done by making a large incision in the abdomen (an open procedure) or by making small incisions and using a small camera to guide the doctor through the surgery (laparoscopic approach).

Today, a variation of the BPD procedure is performed called the biliopancreatic diversion with a duodenal switch (BPD-DS).  This improves on the standard BPD procedure because BPD-DS keeps a larger portion of the stomach intact, including the pyloric valve that regulates the release of stomach contents into the small intestine.  Most of the duodenum is also retained. As with BPD, the patient must be closely monitored following the surgery to ensure nutritional deficiencies do not occur.

Advantages of Biliopancreatic Diversion:

  • Produces the greatest amount of weight loss when compared to other weight loss surgeries (primarily due to the level of malabsorption achieved).
  • Ability to consume larger meals than with other surgeries that are restrictive in nature.
  • Long term weight loss can be successful if patient follows strict guidelines pertaining to diet, nutritional supplementation, exercise, and lifestyle.

Disadvantages/Risks of Biliopancreatic Diversion:

  • Increased chance of side effects and long-term problems than with traditional gastric bypass surgeries such as Roux-en-Y.
  • A strict vitamin regimen must be followed explicitly to avoid serious health problems such as protein malnutrition, anemia, and bone disease.  Patients must be monitored for these conditions on a regular basis.
  • Excessive bloating can occur when high fat content foods are consumed.  This can be accompanied by foul smelling flatulence and bowel movements.
  • Bowel movements can be frequent with a watery consistency while the intestinal tract is adapting to the change.  This condition can fade over time but for some patients remains permanent.
  • Reflux and ulcers can occur as a result of the bile, pancreatic and digestive juices being re-routed.  The BPD-DS (Duodenal Switch) operation has decreased the frequency of this side effect.