A Biliopancreatic Diversion (BPD) makes the stomach smaller to change the normal process of digestion. It allows food to bypass some of the small intestine so that you absorb fewer calories.
A Biliopancreatic Diversion combines the removal or exclusion of 2/3rds of the stomach along with a long intestinal bypass.
Reducing the size of the stomach makes it easier to fill up and decreases hunger, while the intestinal bypass reduces the absorption of fat.
A Biliopancreatic Diversion is prescribed for people who are morbidly obese (BMI>40), who have been unable to achieve satisfactory weight loss by traditional methods of diet and exercise.
Sometimes it is offered to patients as part of a two stage Bypass operation particularly if they are super obese (BMI>60) because it allows good weight loss until the patient gets down to a safe weight and the more radical bypass can then be offered laparoscopically when they are at a safer weight.
Weight loss seems to be of the same order as a LAP-BAND – 50 – 60% excess weight loss over two years but it is not adjustable.
Biliopancreatic Diversion might also be a good option for a patient who’s LAP-BAND requires revision and they have already lost a lot of weight but do not want a full bypass.
The capacity to eat is greater than with the other operations, and the eventual weight loss is the best of all the operations but if fatty foods are overeaten e.g. a hamburger and fries then diarrhoea and foul flatus will result.
- Greater stomach capacity (200-250 mls) therefore can eat a small main meal instead of an entrée portion
- Best weight loss of all techniques 70-90% excess weight loss over 2 years
- Weight loss is well maintained
- Adjustable and partially reversible, but only by further surgery
- A very good option for revision if other techniques have failed
- Open operation (usually), therefore greater operative risks e.g infection, bowel leak, clots to legs and lungs, wound infection, hernia, chest infection. Risk of Death 1:200
- Malabsorption to some minerals vitamins and protein. Patients must commit to taking lifelong supplements of the fat soluble vitamins (A D E K) Calcium and sometimes Iron
- Risk of deficiency state e.g. Iron deficiency anaemia or osteoporosis if supplements not taken
- Take longer to recover (6-8 weeks off work)
- Requires removal of gallbladder because of high incidence of stone formation
- Increased stool frequency 2-4/day
- Flatulence if fatty foods eaten