Biliopancreatic Diversion
Weight loss surgery falls into three main categories.
The first is known as malabsorption surgery and is based upon the principally
of allowing the patient to continue to eat normally and then re-routing food
through the digestive system so that the body is able to absorb only a small
fraction of the calorific value of the food eaten.
The second is referred to as restrictive surgery in which the patient's
stomach is drastically reduced in size and the quantity of food which the
patient can eat, and consequently the number of calories that the body can
adsorb, is severely restricted.
The third category of surgery is simply a mixture of the first two providing
for both a restricted intake and poor calorific absorption.
Biliopancreatic diversion (BPD) is a modern improvement on early attempts at
malabsorption surgery and was pioneered by Professor Nicola Scopinaro at the
University of Genoa. Biliopancreatic diversion is also sometimes referred to as
the Scopinaro procedure.
The first part of the procedure involves the removal of a section of the
stomach in order to reduce the quantity of food that the patient can eat. In the
case of BPD however the remaining section of stomach is considerably bigger than
that seen in restrictive surgery and patients are still able to eat large
quantities of food. While it could be argued that BPD should be classed as a
mixed procedure, the restrictive element here is very much secondary to the
remainder of the procedure.
The second part of the procedure involves the construction of a long limb to
join the stomach to the lower portion of the small intestine leaving a short
common channel for the re-routed new digestive path and the newly bypassed upper
small intestine, which includes both the duodenum and the jejunum.
Although BPD has proved very effective in terms of weight loss, and shows
good weight loss maintenance many years after surgery for the majority of
patients, the malasorptive element of the operation is so potent that it often
leads to a serious problem of protein malnutrition.
As a result, biliopancreatic diversion is rarely used today and has been
largely replaced by a procedure developed by Dr Hess in 1988 which takes
Scopinaro's procedure and combines it with a duodenal switching procedure
described by Dr DeMeester in 1987.
The resultant hybrid operation, known as a biliopancreatic diversion with
duodenal switch (BPDDS) allows part of the duodenum to remain in the digestive
tract and reduces many of nutritional problems seen in the original BPD
procedure. The reduced malabsorption effects of the BPDDS are also countered by
a more radical form of gastrectomy creating a sleeve along the natural curvature
of the stomach which reduces the effective size of the stomach further and moves
BPDDS into the class of mixed weight loss surgical procedures.
Biliopancreatic diversion with duodenal switch is a popular and widely used
form of surgery today but it is also one of the most complex forms of weight
loss surgery. Consequently, anyone contemplating this particular route should
seek out a highly experienced surgeon and should ensure that there is a good
life-long follow-up program in place.
More articles about gastric bypass surgery:
Is The Lap Band Operation The Answer For Obese Teenagers? - As obesity rates continue to rise the number of teenagers undergoing weight loss surgery is also rising. This article looks at whether not the lap band operation presents a realistic option for adolescents.
The Adjustable Gastric Band - Although a relatively new form of weight loss surgery gastric banding, and in particular the use of the adjustable gastric band, is becoming increasingly popular.
Surgery For Morbid Obesity Is Not Simply About Losing Weight - While surgery for morbid obesity is clearly designed to help severely obese individuals to lose weight it is, or at least should be, designed to do a great deal more.
Revisional bariatric surgery associated with high risk for perioperative ... ...
16 Feb 2010 at 8:58am
Revisional bariatric surgery associated with high risk for perioperative ...
Endocrine Today
The most common revisional procedure performed was conversion to a variant of biliopancreatic diversion with Roux-en-Y bariatric surgery in 62.5% of ...
Complications Common in Bariatric RevisionsMedPage Today
Study Finds Higher Risk of Complications After B...
Plasma Nonesterified Fatty Acid Intolerance and Hyperglycemia Are Associated ...
4 Mar 2010 at 4:47pm
Plasma Nonesterified Fatty Acid Intolerance and Hyperglycemia Are Associated ...
Journal of Clinical Endocrinology and Metabolism
... who previously had impaired glucose tolerance or type 2 diabetes but at the time of study had normal glucose tolerance after biliopancreatic diversion). ...
Mimicking gastric bypass effects sheds weight - Johns Hopkins News-Letter
26 Feb 2010 at 12:25am
Mimicking gastric bypass effects sheds weight
Johns Hopkins News-Letter
... compared with other bariatric surgery procedures (eg gastric banding, vertical banded gastroplasty and biliopancreatic diversion)," said Megan Dailey, ...
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