Biliopancreatic Diversion - Obesity/Bariatric Surgery

Biliopancreatic Diversion Abroad

The Biliopancreatic diversion procedure is the creation of Prof Nicola Scopinaro from Italy and it was introduced in 1979. The procedure combines the benefits of restriction and mal-absorption. Since 1979, more than 10,000 cases have been carried out world-wide with excellent results, with Prof Nicola Scopinaro performing over 2300 surgeries.

The operation combines initial restriction of food intake with a major fat and starch malabsorption. The malabsorption takes place without the side effects of the small bowel bypass procedure. The flushing of this loop with bile and pancreatic juices prevents the stagnation and bacterial overgrowth that led to septic problems with small bowel bypass. The weight loss achieved through this procedure is the best compared to any available weight loss procedure and weight regain is less likely to occur because of the inability to absorb more than 25% of ingested fat and starch. Prof Scopinaro claims a long-term weight loss of 73% of excess body weight.

The Biliopancreatic diversion procedure changes the normal process of digestion by making the stomach smaller. It allows food to bypass part of the small intestine so that fewer calories are absorbed. Because of the risks, this surgery is for people who suffer from morbid obesity with a BMI higher than 50.  

Types of biliopancreatic diversion

There are two main types of biliopancreatic diversion surgeries: a biliopancreatic diversion and a biliopancreatic diversion with duodenal switch. Most surgeons will not perform duodenal switch surgery unless the patient has a BMI higher than 50 and the weight is causing serious health problems.

• In a biliopancreatic diversion, part of the stomach is removed and the remaining part 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, which is the valve that controls food drainage from the stomach. Another name for this surgery is duodenal switch.

Causes of obesity

• Genetics
• A diet high in simple carbohydrates
• Physical inactivity
• Some medications (antidepressants, anticonvulsants, diabetes medications or certain hormones)
• Frequency of eating
• Psychological factors (boredom, sadness, stress, or anger)
• Social issues (e.g. lack of money to purchase healthy foods)
• Diseases (insulin resistance, hypothyroidism, polycystic ovary syndrome, Cushing's syndrome)

Symptoms of obesity

The health risks associated with obesity include:

• breathing disorders (e.g., sleep apnea, chronic obstructive pulmonary disease)
• certain types of cancers (e.g., prostate and bowel cancer in men, breast and uterine cancer in women)
• gastroesophageal reflux disease (GERD)
• high blood pressure
• high cholesterol
• joint disease (e.g., osteoarthritis)
• coronary artery (heart) disease
• depression
• diabetes
• gallbladder or liver disease
• stroke

How is the procedure performed?

The lower part of stomach is removed leaving a pouch of between 250 and 400ccs. The duodenum is closed over. The small bowel is measured backwards from the point where it joins the large bowel or colon a distance of 250cm and the small bowel is cut across at this point. The lower divided end is connected to the stomach pouch. The bottom end of the upper section is joined to the lower loop so as to make a new opening from the point where it joins the colon.

Benefits of the biliopancreatic diversion procedure

• Best weight loss results of all surgeries
• Eating capacity is greater than other surgeries
• Produces the greatest amount of weight loss when compared to other weight loss surgeries
• 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.
• Continued weight loss for 18-24 months post surgery
• Many patients maintain a weight loss of 75-80% of excess weight 10 years post-op
• Adjustable and partially reversible but only with additional surgery
• Good option for revision if other techniques have failed
• Improved health problems associated with severe obesity (ie. Diabetes, high blood pressure, sleep apnea, etc.)
• Improved mobility and quality of life

The patient will be able to eat a very small amount of food, which will reach the colon much faster than normally because it will pass through only 40% (275cm) of the small bowel. This means less time to fully digest food.

The bile from the liver and the pancreatic juice from the pancreas, two of the most important digestive juices, have only 1/10 of the normal time to digest the food in the small bowel. This means that fats, starches and proteins will not be broken so they will not be totally absorbed by the organism. Only approximately 25% of these are absorbed. This means there is a major alteration in the patient’s digestive processes with controlled mal-absorption of nutrients. The poorly digested food passes rapidly through the colon and is lost to the system with resultant initial weight loss and long term weight control

A smaller stomach means less food eaten and a bypasses intestine means the absorption of fewer calories and more weight loss. But you still need to adopt healthy habits, such as eating healthy and doing exercise. The recovery period for this procedure is 3-6 months and it is common for patients to feel weak and have periods of nausea and even vomiting during this time.

Cost of Biliopancreatic Diversion

The Biliopancreatic Diversion costs depend on the geographical location of the facility.  The intervention surgery is not performed widely, and is available at only a handful of medical facilities around the world, and by a handful of surgeons, so costs can be high, and may or may not be covered by medical insurance. Choose a bariatric surgeon with experience and expertise in all bariatric surgical procedures. In addition, it is important that your bariatric surgeon be a member of a domestic or international Society of Bariatric Physicians, and that he or she performs the procedure in a JCI (Joint Commission International) accredited quality hospital or facility.

Choosing a Weight Loss Surgeon

Before undergoing weight loss surgery, it is important to research doctors and make sure that he or she has had ample experience in that particular form of surgery. Since the Biliopancreatic Diversion procedure is not done frequently, it is important to find state-of the art facilities and knowledgeable surgeons and hospital staff to perform the procedure. Always verify credentials, accreditation and expertise before choosing a particular bariatric surgeon for this procedure. 

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