Biliopancreatic Diversion for Surgical Weight Loss

By the late 1970s, surgeons had learned from the JIB experience and gained an idea of what not to do for surgical weight loss. The next major bariatric surgical weight loss procedure to emerge came out of Italy in 1976. Dr. Nicola Scopinaro of the University of Genoa revised the JIB procedure so that most of the small intestine remained intact, thus reducing the chances of liver or kidney problems.

To achieve maximum weight loss, Scopinaro's procedure used two components instead of one. First, approximately 2/3 of the stomach was removed to moderately restrict the amount of food that can be consumed at one time. Then the outlet to the stomach was connected to the final segment of the small intestine. By diverting food through this new "limb," the nutrients were effectively separated from the bile and pancreatic enzymes that would break them down. As a result, BPD greatly reduced nutrient absorption and caloric intake.

The first to combine the restriction of food intake and malabsorption, BPD is also the first procedure to remain in usage (albeit limited) more than two decades after its advent. In 1996, Scopinaro reported that after 18 years of follow-up, his patients maintained an excess weight loss of 72%.2 According to the American Society of Bariatric Surgery, BPD has yielded the best long-term results published to date.

The BPD is also unique because it is the only current procedure that allows you to eat normal quantities of food and still achieve excellent weight loss. But there's a catch. The procedure still carries some of the malabsorptive complications of JIB, including loose stools, malodorous gas, and serious deficiencies in protein and minerals such as calcium. BPD patients must take vitamin supplements for the rest of their lives to avoid malnutrition and bone demineralization.

In 1993, a group of Canadian doctors published the first results of a modification of the BPD procedure known as the biliopancreatic diversion with duodenal switch (BPDDS).3 The BPDDS preserves the pyloric valve that connects the stomach to the beginning portion of the small intestine. In addition, physicians increase the length of the small intestine left intact. As a result of these adjustments, this variant reportedly carries fewer complications but with comparable or greater weight loss.

Nonetheless, BPD is the still the most complicated and extreme bariatric surgical weight loss procedure in use. While it produces profound weight loss, it also carries a high risk of nutritional and metabolic problems. This led researchers to continue searching for an even safer approach for surgical weight loss. Presently, the BPD remains in use, especially in Europe, but is less popular in than some of the newer procedures available in the United States.

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