Biliopancreatic Diversion With Duodenal Switch
Biliopancreatic diversion (BPD) is one of the oldest surgical procedures developed in 1970 for weight loss and metabolic effects by the Italian surgeon Nicola Scopinaro. During this procedure, using open or laparoscopic technique, the stomach is stomachdivided horizontally. The larger proximal part of stomach is then surgically connected to the distal portion of the small bowel. After this operation, food advances from the reduced stomach to the distal intestine bypassing a long portion of the small bowel (Figure). This procedure decreases oral intake and reduces the absorption of nutrients, especially of fat, and calories.
BPD is beside the BPD-DS one of the most effective bariatric procedures in terms of weight loss, long-term maintenance and improvement of obesity associated diseases. Weight loss is 70-80% of excess of weight with low risk of weight regain at long-term. Among all bariatric procedures, BPD provides high chance of improvement or resolution of different diseases secondary to the obesity such as type 2 diabetes, hypertension, dyslipidemia, metabolic syndrome, fatty liver disease and obstructive sleep apnea.
The risk of postoperative complications after biliopancreatic diversion is higher compared with other bariatric procedures including bleeding, infections and deep venous thrombosis.
Due to the important reduction in absorption of nutrients and calories secondary to this procedure, some of the most important long-term complications are nutritional deficiencies such as protein, iron, vitamin D, zinc, calcium and folate deficiencies. For this reason, this procedure requires close medical monitoring, strict adherence to dietary guidelines and vitamin and mineral supplementation.
Common side effects include increased number of daily bowel movements, gas, bloating and risk of anastomotic ulcer. The original BPD procedure becomes a rare option in the field of bariatric and metabolic surgery and was never offered in USA. It is a safe secondary procedure after previous VBG (vertical banded gastroplasty).