Biliopancreatic Diversion (BPD) Gastric Bypass

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About the BPD

The Biliopancreatic Diversion (BPD), originally developed by Dr. Scopinaro in Italy, employs a pre-dominantly malabsorptive technique to induce long-term weight loss. This extensive gastric bypass operation was once a commonly performed procedure; however, today it is not widely used due to the risk of nutritional deficiencies.

The BPD: Malabsorption

Biliopancreatic diversion (BPD) is one of the oldest surgical procedures developed for weight loss. Using an open or laparoscopic approach, the distal (lower) portion of the stomach is resected leaving a small proximal stomach. It is then anastomosed (connected) to the ileum (distal small bowel). After this operation, food travels from the reduced stomach to the distal intestine by passing a long segment of the small bowel. This procedure decreases oral intake and reduces the absorption of the nutrients and calories eaten. Less food and less calories result in achieving fast weight loss. For this reason, BPD was once an excellent way to achieve weight loss for a severely obese individual.

Today, a variation of the BPD procedure is performed called the biliopancreatic diversion with a duodenal switch (BPD-DS). This improves on the standard BPD procedure because BPD-DS keeps a larger portion of the stomach intact, including the pyloric valve that regulates the release of stomach contents into the small intestine. Most of the duodenum is also retained. As with BPD, the patient must be closely monitored following the surgery to ensure nutritional deficiencies do not occur. The addition of the duodenal switch (DS), was termed the “second generation BPD”

What can you expect from the BPD

The BPD has been demonstrated to be one of the most effective bariatric procedures in terms of total weight loss, the long-term maintenance of this weight loss, and for improvement of associated diseases. The weight loss achieved is reported to be on average 70-80% of excess of weight and it is generally maintained long-term. Among all current bariatric procedures, the BPD provides the highest likelihood of improvement, or even resolution of many different diseases secondary to the obesity such as type 2 diabetes, hypertension, dyslipidemia, metabolic syndrome, fatty liver disease and obstructed sleep apnea.

Due to the complexity of the operative technique, the risk of postoperative complications after BPD is higher when compared with other bariatric procedures. Perioperative complications include bleeding, infections, gastrointestinal leakage, deep venous thrombosis, pulmonary embolism, and wound issues.

Long-term complications are mainly nutritional in nature and are due to the malabsorption created by the BPD. They include dehydration, protein, vitamin and mineral deficiencies. The vitamin and minerals at risk include iron, zinc, calcium, folate B12, and the fat soluble vitamins (A, D, E, K). Therefore, patient sunder going the BPD procedure must have close medical monitoring, strict adherence to proper dietary guidelines, and must be compliant with vitamin and mineral supplementation.

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Am I a BPD candidate

To be a candidate for any type of weight loss surgery, the individual must be severely (BMI > 35) or morbidly (BMI > 40) obese. Morbid obesity is usually defined as being about 100 pounds over your ideal body weight. A better way of defining morbid obesity is by using the Body Mass Index (BMI). BMI is a calculated number that takes weight and height into consideration. A person weighing 300 pounds who is 5ft tall will have a higher BMI than a person weighing 300 pounds but is 6ft tall.

To determine if you qualify for the BPD, you can start by entering your weight and height into a BMI calculator.

Insurance companies often will have additional criteria to qualify for weight loss surgery. Our office can help you determine what those are. Below you will find the basic criteria most insurance companies use to determine if patients qualify for weight loss surgery:

  • A Body Mass Index (BMI) equal to or greater than 40, regardless if medical problems or co-morbidities are present or not.

  • A Body Mass Index (BMI) equal to or greater than 35 and experiencing severe negative health effects or co-morbidities, such as high blood pressure, diabetes, and/or sleep apnea.

How does the BPD work?

The BPD takes advantage of restriction and malabsorption. Approximately 1/3 of the stomach remains and roughly three-fourths of the small intestine is bypassed (no food passes through 3/4th of the intestine).

The bypassed small intestine, which carries the bile and pancreatic enzymes that are necessary for the breakdown and absorption of protein and fat, is reconnected to the last portion of the small intestine allowing the bile and enzymes to mix with the food stream. The food does not mix with the bile and pancreatic enzymes until very far down the small intestine. This results in a significant decrease in the absorption of calories and nutrients (particularly protein and fat) as well as nutrients and vitamins dependent on fat for absorption (fat soluble vitamins and nutrients). Lastly, the BPD, similar to the gastric bypass and sleeve gastrectomy, affects guts hormones in a manner that impacts hunger and satiety as well as blood sugar control. The BPD is considered one of the most effective surgery for the treatment of diabetes among those that are described here.

Advantages of BPD

  • Produces greater amount of weight loss when compared to other weight loss surgeries (primarily due to the level of malabsorption achieved).

  • Ability to consume larger meals than with other surgeries that are restrictive in nature.

  • Long term weight loss can be successful if patient follows strict guidelines pertaining to diet, nutritional supplementation, exercise, and lifestyle.

Disadvantages / Risks of BPD

  • Increased chance of side effects and long-term problems than with traditional gastric bypass surgeries such as Roux-en-Y.

  • A strict vitamin regimen must be followed explicitly to avoid serious health problems such as protein malnutrition, anemia, and bone disease. Patients must be monitored for these conditions on a regular basis.

  • Excessive bloating can occur when high fat content foods are consumed. This can be accompanied by foul smelling flatulence and bowel movements.

  • Bowel movements can be frequent with a watery consistency while the intestinal tract is adapting to the change. This condition can fade over time but for some patients remains permanent.

  • Reflux and ulcers can occur as a result of the bile, pancreatic and digestive juices being re-routed. The BPD-DS (Duodenal Switch) operation has decreased the frequency of this side effect.

Deciding on the BPD

The decision about which operation is best for you is a complicated one. The decision to proceed is based on the premise that the treatment should be less harmful than the disease being treated. Please read the “obesity & weight loss surgery” section of our website to learn about the disease, and the benefits weight loss surgery can offer to morbidly obese patients. Although the information presented throughout our website may be helpful, you will be able to learn substantially more about the benefits and risks of the BPD operation during your consultation with the bariatric surgeon.