Biliopancreatic Diversion

On video: Biliopancreatic Diversion Procedure

A biliopancreatic diversion (BPD), or Scopinaro procedure, is a "malabsorptive" operation, which causes food to be poorly digested and absorbed. In this procedure, about two-thirds of the stomach is removed. The remaining portion, about two to three cups in volume (the size of a can of soda), is re-connected to the ileum, a part of the small intestine, bypassing almost nine feet of this digestive organ. In this arrangement, all enzymes and bile from the liver and pancreas meet ingested food further down in the ileum, at about 20 to 40 inches from the large intestine (colon), reducing the amount of food that can be digested and absorbed before it reaches the large intestine. In other words, the distance between the stomach and the colon is significantly shortened.

A BPD can be performed alone or with a duodenal switch (DS). A major difference between the BPD and the BPD/DS is that, in the former, the lower part of the stomach is removed, while in the latter, the left side of the stomach removed. Another difference is that the DS maintains the presence of the pylorus valve (a muscular valve that separates the stomach from the duodenum). There are advantages and disadvantages to each of these operations, which can be further discussed with your surgeon. Both have been performed extensively in Europe. They are much less common in the United States, and only a handful of surgeons here do the procedure laparoscopically.

Advantages:

  • Weight loss ranges from 70 to 90 percent of excess body weight over the first two years. This equals roughly 100 to 200 pounds, depending on your original weight. After two years, there is almost no weight regain. It is one of the most effective operations for losing a large amount weight and keeping it off.

  • The procedures improve or cure the majority of existing co-morbidities.

Disadvantages:

  • Since only 25 percent of fat is absorbed after this operation, most patients will experience frequent, foul-smelling, pasty bowel movements, especially after eating fatty food. Other side-effects include flatulence and bloating.

  • Only part of the operation is reversible. The small intestine can be reconnected to its original position, however, the stomach pouch will remain smaller for several years. However, if the stomach pouch does stretch, patients may regain some weight.

  • Since BPD bypasses a large portion of the small intestine, less food, especially fat, is absorbed by the body, which often leads to nutritional problems. To avoid nutritional deficiencies, you will need to take daily vitamin and mineral supplements everyday for the rest of your life. These include a multivitamin, calcium, vitamin B12, and iron, as well as vitamins A,D,E, and K (which are absorbed with fat). You will also need to increase the proportion of protein in your diet, since you'll be eating less food overall. Blood tests must be performed every three months for the first year to check your nutritional status, and then annually.

  • Some patients may experience heartburn or ulcers in the small intestine. Therefore, you may need to take an anti-ulcer medication after surgery.