BILIOPANCREATIC DIVERSION :(BPD)

A modern variant of the Jejuno-ilea, Bypass (JIB) is Biliopancreatic Diversion, (BPD), a procedure which is differs from JIB in that no small intestine is defunctionalized and, conssequently, liver problems are much less frequent. This procedure was developed by Professor Nicola Scopinaro, of the University of Genoa, Italy.(Scopinaro, Gianetta et al. 1996)

Figure:

This procedure has two components. A limited gastrectomy result in reduction of oral intake, inducing weight loss, eapecially eduring the first postoperative year. The second component of the operation, construction of a long limbRoux-en-Y anastomosis with a short comman "alimentary" channel of 50 cms length. This creates a significant malabsorptive components which acts to maintain weight loss long term. Dr Scopinaro recently publish long term results of this operation, reporting 72% excess body weight loss maintained for 18 years. These are the best results, in term of weight loss and duration of weight loss, reported in the bariatric surgical literature to this date

From the patient's perspective, the greate advantages of this operation are the ability to eat large quantities of food and still achieve excellent, long term weight loss results. Disadvantages of the procedure are the association with loose stools, stomal ulcers, offensive body odor and foul smelling stools and flatus.The most serious potential complication is protein malnutrition, which is associated with hypoalbuminemia, anemia, edema, aasthenia, alopecia, generallyrequires hospitalization and 2-3 weeks hyperalimentation. BPD patients need to take supplemental calcium and vitamins, particularly Vitamin D, lifelong. Because of this potential for significant complications, BPD patients require lifelong follow-up. In BPD patients who have received 200-300 cm alimentary limbs bacause of protein malnutrition concerns, the incidence of protein malnutrition fell dramatically to range from 0.8% to 2.3%

Variants of this operation have been devised in an attempt to reduce the incidence of stomal ulceration and diarrhea using the techniques of sleeve resection of the stomach which maintain continuity of the gastriclesser curve and duodenal switch which maintains continuity of the gastro-duodeno-jejunal axis.(Marceau, Biron et al. 1993) This technique essentially eliminates stomal ulcer and dumping syndrome.

BPD and its variants are the most major procedures performed for obesity and it follows that prospective patients who wish to consider BPD should seek out experienced surgeons with life-long follow up programs.

Listing of complications of biliopancreatic diversion:

1. Protein Malnutrition 15%
   
2. Incisional hernia 10%
   
3. Intestinal obstruction 1%
   
4. Acute biliopancreatic limb obstrction
   
5. Stomal Ulcer 3.0%

Bone Demineralization:

1. Pre-op 25%; at 1-2 yrs, 29%; at 3-5 yrs 53%; at 6-10 yrs 14%
   
2. Hemorrhoids 4.3%
   
3. Acne 3.5%
   
4. Night Blindness 3%
   
5. Operative Mortality 0.4% -0.8%(1122 subjects, 1984-1993)