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Bilio-pancreatic Diversion

A biliopancreatic diversion is a weight loss surgery where the normal process of digestion is changed by making the stomach smaller. By this procedure, food bypasses part of the small intestine so that you absorb fewer calories. This surgery is for people who are more than severely obese. Super obesity means that BMI (body mass index) is 50 or higher.

After surgery, the patient will feel full more quickly than when the stomach was its original size. This reduces the amount of food the patient will want to eat. Bypassing part of the intestine also means that fewer calories are absorbed. This leads to weight loss.

There are two biliopancreatic diversion surgeries: a biliopancreatic diversion and a biliopancreatic diversion with duodenal switch. Most surgeons will not perform duodenal switch surgery except in super obesity.

Bilio Pancreatic
  • In a biliopancreatic diversion, part of the stomach is removed. The remaining part of the stomach is connected to the lower portion of the small intestine. People who have this surgery must take vitamin and mineral supplements for the rest of their lives.
  • In a biliopancreatic diversion with duodenal switch, a different part of the stomach is removed and the surgeon leaves the pylorus intact. The pylorus is the valve that controls food drainage from the stomach. The DS is more effective in achieving excellent weight loss in the extremely obese. In the DS, a sleeve resection of the stomach is performed by removing about 2/3 of the stomach, maintaining continuity of the gastric lesser curve. The stomach remains attached the first segment of the small intestine, the duodenum, which allows pylorus, the valve that controls food drainage from the stomach, to be left intact. The 2nd part of duodenum is then separated from the rest of the small intestine. The duodenum is then attached to the lowest part of the small intestine, bypassing the majority of the second and third segments of the small intestine. The small intestines are arranged so that the section where the food mixes with the digestive juices is fairly short. No small intestine is defunctionalized.

These procedures can be done by making a large cut in the belly (an open procedure) or by making a small cut and using small tools and a camera to guide the surgery (laparoscopy).

What To Expect After Surgery

There may be postoperative pain, which will need pain medication for the first week or so after surgery. Because the surgery makes the stomach smaller, you will get full more quickly when you eat. Food also may empty into the small intestine too quickly. This is called dumping syndrome. It can cause diarrhea and make you feel faint, shaky, and nauseated. It also can make it hard for your body to get enough nutrition. Having a duodenal switch reduces the risk of dumping syndrome.

Depending on how the surgery was done (open or laparoscopic surgery), you'll have to watch your activity during recovery.

Eating after surgery

Your doctor will give you specific instructions about what to eat after the surgery. For about the first month after surgery, your stomach can only handle small amounts of soft foods and liquids while you are healing. It is important to try to sip water throughout the day to avoid becoming dehydrated. You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements.

Bit by bit, you will be able to add solid foods back into your diet. You must be careful to chew food well and to stop eating when you feel full. This can take some getting used to, because you will feel full after eating much less food than you are used to eating. If you do not chew your food well or do not stop eating soon enough, you may feel discomfort or nausea and may sometimes vomit. If you drink a lot of high calorie liquid such as soda or fruit juice, you maybe no weight loss. If you continually overeat, your stomach may stretch. If your stomach stretches, you will not benefit from your surgery.

This surgery removes the part of the intestine where many minerals and vitamins are most easily absorbed. Because of this, you may have a deficiency in iron, calcium, magnesium, or vitamins. It's important to make sure you get enough nutrients in your daily meals to prevent vitamin and mineral deficiencies. You may need to work with a dietitian to plan meals. And you may need to take extra vitamin B12.

Why It Is Done

Weight loss surgery is suitable for people who are severely overweight and who have not been able to lose weight with diet, exercise, or medicine.

Most surgeons will not perform duodenal switch surgery unless you are super obese (body mass index (BMI) of 50 or higher) and your weight is causing serious health problems.

It is important to think of this surgery as a tool to help weight loss. It is not an instant fix. You will still need to eat a healthy diet and get regular exercise. This will help you reach your weight goal and avoid regaining the weight you lose.

Advantages

  • The primary advantage of duodenal switch (DS) surgery is that it results in a very high percentage of excess weight loss for obese individuals, with a very low risk of significant weight regain.
  • Various clinical studies showed resolution of type 2 diabetes [90%], hyperlipidemia [95%], sleep apnea [90%], and hypertension [80%]. The results are so favorable that some surgeons are performing the "switch" or intestinal surgery on non-obese patients for the benefits of curing the diabetes.
  • Because the pyloric valve between the stomach and small intestine is preserved, people who have undergone the DS do not experience the dumping syndrome common with people who've undergone the Roux-en-Y gastric bypass surgery.
  • Diet following the DS is more normal and better tolerated than with other surgeries. The malabsorptive component is fully reversible.
  • Liver problems are much less frequent and the procedure essentially eliminates stomal ulcer.

Risks and Complications:

  • The malabsorptive element of the DS requires that those who undergo the procedure take vitamin and mineral supplements above and beyond that of patients having the gastric bypass surgery.
  • Like Gastric bypass patients, DS patients require lifelong and extensive blood tests to check for deficiencies in vitamins and minerals. Follow-up care is non-optional and must continue for as long as the patient lives.
  • DS patients also have a higher occurrence of smelly flatus and diarrhea, although both can usually be mitigated through diet, including avoiding simple carbohydrates and fatty foods.
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