Biliopancreatic Diversion BPD
These operations combine the removal or exclusion of 2/3rds of the stomach, along with a long intestinal bypass, which significantly reduces the absorption of fat. The capacity to eat is greater than with the other operations, and the eventual weight loss is the best of all the operations, but if fatty foods are overeaten e.g. a hamburger and fries, then diarrhoea and foul flatus will result.
Advantages:
- Greater stomach capacity (200-250 mls); therefore, can eat a small main meal instead of an entrée portion
- Best weight loss of all techniques: 70-90% EWL over 2 years
- Weight loss is well maintained
- Adjustable and partially reversible, but only by further surgery
- A very good option for revision if other techniques have failed
Disadvantages:
- Open operation (usually), therefore greater operative risks, e.g. infection, bowel leak, clots to legs and lungs, wound infection, hernia and chest infection. Risk of death is 1:200.
- Malabsorption to some minerals, vitamins and proteins. Patients must commit to taking lifelong supplements of the fat-soluble vitamins (A, D, E, K) calcium and sometimes iron
- Risk of deficiency state, e.g. Iron deficiency anaemia or osteoporosis if supplements are not taken
- Take longer to recover (6-8 weeks off work)
- Requires removal of gallbladder because of high incidence of stone formation
- Increased stool frequency: 2-4/day
- Flatulence if fatty foods are eaten
Sometimes it is offered to patients as part of a two-stage bypass operation, particularly if they are super obese (BMI>60) because it allows good weight loss until the patient gets down to a safe weight. The more radical bypass can then be offered laparoscopically when they are at a safer weight.
The residual stomach capacity is about 200 mls, so a generous entrée should be possible.
The weight loss seems to be of the same order as a lap band (50-60% EWL) over two years, but it is not adjustable.
It might also be a good option if patients have a problem with their lap band requiring revision, have already lost a lot of weight and don't want a full bypass.
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