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Biliopancreatic diversion

Biliopancreatic diversion removes up to 70% of the lower stomach in order to restrict the amount of food that can be consumed. It is similar to Roux-en-Y gastric bypass, except the remaining stomach is larger than the RNY gastric bypass pouch. This allows the patient to eat larger meals — about 2-3 cups' worth. The remaining portion of the stomach is directly attached to the small intestine, allowing for malabsorption (decreased or reduced absorption of calories), which leads to weight loss. BD allows the patient to only absorb 25% of the fat they consume. This procedure is done through open surgery or laparoscopically.

BD is a highly complicated procedure and usually costs around $25,000-$35,000, depending on hospital stay costs, geographical area, and other factors. The United States government approved coverage of biliopancreatic diversion under Medicare, with some health and treatment location stipulations.

History

A biliopancreatic diversion was originally developed as an improvement of the Jejuno-ileal Bypass (JIB), which was a weight loss procedure developed in the 1970s-1980s. The American Society of Metabolic & Bariatric Surgery states that JIB had serious side effects, and Professor Nicola Scopinaro, working at the University of Genoa, Italy, created biliopancreatic diversion as a solution in 1996. The biliopancreatic diversion procedure is often combined with the duodenal switch. The differences between the original BD procedure and this hybrid one is that the BD/DS keeps the pyloric valve intact and maintains a portion of the duodenum, according to duodenalswitch.com. This combined procedure often results in consistent weight loss and low weight regain.

Ideal candidate criteria

The ideal candidate criteria for BD is similar to other weight-loss surgeries. The patient must be 18 years of ago or older, have a BMI over 40, or have a BMI over 35 with accompanying co-morbidities, such as high blood pressure or asthma. Candidates must also not have a history of drug abuse or depression (or any other significant psychological disorders) and many are screened by a psychologist before receiving surgery approval. They must also have repeated attempted to lose weight with other methods.

Besides these general requirements, candidates must be willing to complete a daily vitamin and eating regime, which may be extensive. If not, they may suffer from severe nutritional deficiencies, such as anemia and lack of protein. These may require additional hospitalization and/or more medication, in addition to regular appointments with a nutritionist.

Results and complications

Besides severe issues arising from nutritional deficiencies (malnutrition), other problems after BD may include strong-smelling stools and gas, diarrhea, stomach ulcers, incisional hernias, dumping syndrome, and a higher risk of osteoporosis. The most common nutritional deficiency is anemia, according to Revolution Health. Almost 30% of the BD patients in a 2002 Journal of the American Medical Association study suffered from anemia. The American Society of Metabolic & Bariatric Surgery states that based on Professor Scopinaro's research, most of his patients have kept about 72% of their excess weight off for 18 years after surgery. If this is the true average, then this is the highest percentage of maintained excess weight loss in all weight loss surgeries.

Maintenance

Biliopancreatic Diversion takes lifetime maintenance. If the patient ingests foods that don't have enough protein, or foods that are high in sugar and fat, they may experience malnutrition ailments, including anemia and vitamin deficiencies. Lifetime, regularly scheduled appointments with a nutritionist may be required.

The diet immediately after the surgery is similar to other WLS diets, except many BD patients can begin to eat pureed food sooner. The NYU Medical Center gives its patients only ice chips on the day of surgery, and then only liquids the day after. On the third day, which is usually the day of hospital discharge (depending on the individual), patients are given food that has been pureed, such as veggies, fruit, and soup. In the following weeks after the surgery, patients slowly progress to a diet that includes shredded chicken, beef, or fish, and other soft foods. Eventually, they will be able to eat more “normal” foods, as long as they fit healthy eating guidelines.

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