The biliopancreatic diversion (BPD) is a malabsorptive weight loss surgery, which promotes weight loss primarily through incomplete food digestion and absorption. It is considered a very effective surgical procedure for the treatment of obesity, but it must be considered carefully as a patient will need life-long monitoring and daily vitamin supplements to prevent nutritional and mineral deficiencies. Because of the high risk of nutritional deficiencies, it is used less often than other types of weight loss surgeries.


The biliopancreatic diversion is a combined operation in which changes are made to both the stomach and the intestines. Although the BPD anatomy is similar in principle to the Roux-en-Y Gastric Bypass (RYGBP), it is a more complicated combined operation and fewer bariatric surgeons perform the procedure, especially laparoscopically. Compared to the RYGBP, the stomach pouch is larger which allows patients to eat more and a greater length of the small intestine is bypassed which reduces absorption of calories and nutrients.


Restrictive Aspect of BPD Weight Loss Surgery


With the biliopancreatic diversion weight loss surgery about two-thirds of the stomach is completely removed, unlike the Roux-en-Y Gastric Bypass (RYGBP) in which the stomach is bypassed but not removed. Removing a portion of the stomach somewhat restricts the amount of food that can be eaten at any one time, but the main purpose is to decrease the amount of acid produced by the remaining stomach.


The new stomach pouch is created from the upper stomach area, while the lower stomach section and normal stomach outlet (pyloric valve) is removed. A new stomach outlet is formed which is then joined to the final section of the small intestine. This procedure completely bypasses the first and middle section of the small intestine where most of digestion usually takes place. The bypassed section of the small intestine continues to transport bile and pancreatic digestive juices, but it is reattached near the end of the small intestine where it then mixes with the food.


Malabsorptive Aspect of BPD Weight Loss Surgery


By cutting and rerouting the small intestine, the distance between the stomach and colon (large intestine) is significantly shortened, as is the section of the small intestine in which food and digestive juices are mixed. Calorie and nutrient absorption does not occur once food enters the colon. By shortening the digestion process, the body is not able to fully absorb all of the calories and nutrients from the ingested food, resulting in weight loss.


The section of small intestine where the digestive juices and food mixes is referred to as the common channel. The bypassed section of the small intestine is referred to as the biliopancreatic channel. The section of the small intestine where the food travels is referred to as the alimentary channel. Bariatric surgeons can vary the length of the alimentary channel and the common channel using various formulas to determine what length is most appropriate for each patient.


Advantages of Biliopancreatic Diversion Weight Loss Surgery


Patients are able to eat fairly normal meals, resulting in a high level of patient satisfaction
More rapid weight loss than with purely restrictive weight loss surgery (gastric banding)
Results in the greatest excess weight loss due to high levels of malabsorption
Average weight loss of 75 to 80 percent of excess weight
Successful long-term weight loss possible with proper diet, supplements, exercise
Improves or cures the majority of obesity related health conditions
Disadvantages of Biliopancreatic Diversion Weight Loss Surgery


Malabsorption procedures have a period of intestinal adaptation causing frequent and very soft bowel movements (4-6 per day), which may or may not lessen over time
May cause gas pains, bloating, frequent passing of very smelly gas
Increased risk of gallstones and gallbladder problems
Intestinal irritation
Heartburn or ulcers
Dumping Syndrome
Abdominal hernias, but less likely with laparoscopic surgery
Lifelong monitoring for nutritional and mineral deficiencies
Lifelong vitamin supplementation is required, otherwise health problems can occur, including multivitamin, calcium, vitamin B12, iron, vitamins A, D, E, and K
Malabsorption of fat soluble vitamins (vitamins A, D, E, and K)
Vitamin A deficiency, which causes night blindness
Vitamin D and calcium deficiency, which causes osteoporosis
Vitamin B12 and iron deficiency, which causes anemia, especially in menstruating women
Protein malnutrition
Combined weight loss procedures are more difficult to perform than restrictive procedures
History of Biliopancreatic Diversion Weight Loss Surgery


The Biliopancreatic Diversion (BPD) was first performed by Nicola Scopinaro, MD, thus the procedure is sometimes referred to as the Scopinaro procedure. The BPD was developed as a safer malabsorptive alternative to the now abandoned Jejunoileal Bypass (JIB) weight loss surgery of the 1950's and 1960's. Although the BPD procedure is still performed, it has largely been replaced with a variation known as Bilio-Pancreatic Diversion with Duodenal Switch (BPD-DS). The Duodenal Switch provides many of the benefits of the BPD but with less of the associated problems. As these procedures are more complex and technically demanding than gastric bypass surgery and adjustable gastric banding, they should only be performed by the most experienced bariatric surgeons.