Biliopancreatic Diversion

Surgical Treatment for Patients with Severe Obesity

What is Biliopancreatic Diversion?

Biliopancreatic diversion (BPD) is a surgical procedure that reduces digestion and absorption by delaying the mixing of digestive juices with ingested food. Developed in Italy, this technique was first performed at the University of Genoa in 1976. It is designed to help patients with severe obesity achieve significant weight loss by modifying the digestive process.

How Does It Work?

Biliopancreatic diversion involves two main stages:

Distal Gastric Resection: This stage removes about two-thirds of the stomach, including the pylorus, to reduce the stomach’s capacity.
Biliopancreatic Diversion: The small intestine is divided into two pathways: one carries food, and the other carries biliopancreatic secretions (digestive juices from the liver and pancreas). These pathways remain separate until they meet about 70 cm before the colon, which significantly reduces digestion and absorption, especially of fats and carbohydrates.

This extended separation means that fewer calories are absorbed from food, contributing to effective weight loss.

What Are the Benefits?

After biliopancreatic diversion, patients can lose up to 70% of their excess weight within 12-18 months. Key advantages include:

Significant weight loss without needing to follow a highly restrictive diet.
A more liberal diet compared to other bariatric surgeries, although control of simple sugars (found in fruits, sweets, milk, and alcohol) is still necessary.
Exceptional effectiveness in managing obesity-related conditions like type 2 diabetes and hypercholesterolemia.

What Are the Potential Complications?

Biliopancreatic diversion can have immediate or delayed complications:

Immediate Complications: Risks common to all major surgeries, such as infections or bleeding.
Delayed Surgical Complications: These may include ulcers, intestinal obstruction from adhesions, and incisional hernias.
Nutritional Complications: Due to reduced absorption, patients may face anemia, osteoporosis, vitamin deficiencies, and protein malnutrition.

The procedure can also cause increased bowel movements, which may be foul-smelling and lead to conditions like hemorrhoids. While the diversion provides lasting weight management, it requires careful, lifelong nutritional follow-up.

Biliopancreatic diversion is a complex procedure, not so much because of the surgical risk itself, but due to the long-term post-operative management required.

The diversion works for a lifetime, which means it is effective in maintaining weight loss over the long term. However, it can also lead to lifelong nutritional issues.

Who Can Benefit from Biliopancreatic Diversion?

Have previously undergone weight loss surgery but did not achieve sufficient results.
Suffer from severe metabolic conditions like advanced diabetes or hypercholesterolemia.
Wish to maintain a more natural relationship with food without the need for strict dietary restrictions.
To be eligible, patients must follow a protein-rich diet (including meat, fish, eggs, and cheese) and should not have any intestinal disorders that impair nutrient absorption.

Follow-Up Visits

Post-surgery, regular follow-up appointments and blood tests are vital to ensure dietary needs are met and that supplements are effective. The diet should include high amounts of protein (meat, fish, eggs, cured meats, cheese). Lifelong supplementation with calcium, iron, and vitamins is necessary, as these nutrients may not be fully absorbed after the procedure. If nutritional follow-up is not maintained or if excessive malabsorption occurs, complications like anemia or osteoporosis may arise. In severe cases, a revision surgery may be needed to adjust or reverse the diversion.

Sono previste norme di preparazione?

Before undergoing biliopancreatic diversion, an esophagogastroduodenoscopy is required to identify any conditions affecting the esophagus, stomach, or duodenum.