Biliopancreatic Diversion in the Surgical Treatment of Morbid Obesity

Abstract

Biliopancreatic diversion is a malabsorptive technique of bariatric surgery that has gained wide acceptance in the Western world. It is performed in one of two ways: In its classic form it consists of partial gastrectomy with a Roux-en-Y gastroenterostomy; in its duodenal switch form a vertical sleeve gastrectomy is combined with a duodenoenterostomy. Both techniques realize diversion of biliopancreatic juice, thereby creating a mild form of malabsorption. Weight loss has been approximately 70% of initial excess weight, exceeding that obtained with most other bariatric procedures. Iron, calcium, and vitamin deficiencies may occur, especially with classic biliopancreatic diversion, and must be prevented with adequate supplements during vigorous follow-up. Weight loss is followed by a substantial reduction in the co-morbidities that are present in many morbidly obese patients. Biliopancreatic diversion should be included in each obesity clinic program and be proposed for morbidly obese patients who are having difficulty with the prospect of continuous restraint of food intake or problems due to failed gastric restrictive interventions. The postoperative results in such patients have been good and have substantially improved quality of life and self-esteem in this category of morbidly obese patients.

Long-Term Results of Biliopancreatic Diversion with or Without Gastric Preservation for Morbid Obesity

“…As for weight loss, in our experience, as in Scopinaro et al's [3,[9][10][11][12] and in other [27][28][29][30][31][32] series, we observed that BPD allowed to obtain and to maintain a significant long-term weight loss.…”

“…It is currently believed that BPD, as described by Scopinaro et al [9], and its subsequent successful modifications are effective in curing these diseases through malabsorption [7][8][9][10][11][12][27][28][29][30][31][32]. By contrast, the restrictive procedures, even when performed on a large scale, did not show the same efficacy, especially in controlling type 2 diabetes [27][28][29][30][31][32].…”

“…By contrast, the restrictive procedures, even when performed on a large scale, did not show the same efficacy, especially in controlling type 2 diabetes [27][28][29][30][31][32].…”

“…At present, biliopancreatic diversion can be considered a mainstay among bariatric operations for long-term effectiveness in weight loss and quality of life [7][8][9][10][11][12][27][28][29][30]. It is well-known that in more than 90% of patients, BPD effectively cures the severe obesity-related metabolic disease, such as diabetes type 2, hypertriglyceridemia and hypercholesterolemia, and the metabolic syndrome [21].…”

Advances in the Etiology and Management of Hyperinsulinemic Hypoglycemia After Roux-en-Y Gastric Bypass

“…This operation improves quality of life in the majority of patients 43 and carries a 30-day mortality of 0.3%. 44,45 It is recognized as a leading metabolic procedure in view of its low morbidity compared with other bypass procedures such as biliopancreatic diversion 46,47 and its metabolic superiority compared with non-bypass procedures such as gastric banding. 48 RYGB achieves a number of physiological effects as a consequence of bile flow alteration, reduction of gastric size, altered flow of nutrients, vagal manipulation, and gut hormone modulation.…”