Biliopancreatic Diversion with Duodenal Switch (BPD) for Weight Loss: Information and Specialists

Biliopancreatic diversion is a complex surgical procedure used in bariatric surgery. It is also known as a biliopancreatic bypass. The goal of the procedure is to direct the digestive secretions from the gallbladder and pancreas exclusively to the lower part of the stomach.

Biliopancreatic diversion is classified as a so-called “malabsorptive” procedure. These are procedures that induce a state of artificial malnutrition. The term “malabsorptive” describes the reduction in nutrient absorption from the intestine.

This is achieved by bypassing sections of the small intestine, thereby reducing the length of the intestinal tract. This makes it more difficult to digest

• proteins,
• carbohydrates, and
• fats
• trace elements
• and other digestive enzymes

, thereby reducing calorie absorption.

The advantage of this procedure is reliable weight loss that begins quickly after surgery. This weight-loss method is used for patients with a BMI of 40 kg/m² or higher, or 35 kg/m² or higher if the patient suffers from serious comorbidities, such as diabetes mellitus. 

Obesity is a widespread phenomenon in Western industrialized nations. Experts define morbid obesity as a body weight that is 45 kilograms or more above the normal weight.

In general, people with morbid obesity can expect a shorter life expectancy. Men with obesity live about 13 years less, and women about 8 years less.

Some examples of possible complications include

• joint damage,
• cancer,
• lipid metabolism disorders,
• diabetes, and
• heart disease and
• vascular diseases.

In addition, those affected often suffer from psychological and social problems such as

• feelings of inferiority,
• loneliness,
• social exclusion

and more.

Severe obesity is often genetically determined. Diets, exercise, and other forms of weight loss therefore often fail to produce results or do not provide lasting results.

Surgical intervention, on the other hand, promises reliable and lasting results. It leads to improved health and well-being for those affected. An increase in self-confidence—and thus in quality of life—is also frequently observed.

In biliopancreatic diversion, the surgeon divides a portion of the stomach lengthwise. The surgeon then creates a sleeve-shaped stomach to reduce its volume, similar to a gastric bypass.

If the patient were to resume eating normally after the procedure, they would risk regaining weight. Therefore, the surgeon also short-circuits the small intestine, reducing its length to 2.5 meters. In this way, the small intestine only partially digests the food.

Fatty components, in particular, are broken down only in the large intestine. The rapid weight loss is due to the diarrhea that begins immediately after the operation.

The success rates associated with biliopancreatic diversion speak for themselves. Studies indicate that patients can lose up to 80 percent of their excess weight after about five years. Compared to other procedures, the success rate for Scopinaro diversion is the highest in terms of weight loss and quality of life.

In terms of risk, the extent and complexity of the surgery must be considered. Opening and suturing multiple sections of the gastrointestinal tract can lead to leaks. Here, the surgeon’s experience and attention to detail are crucial.

In addition, there are the usual risks associated with any surgery, including

• infections,
• hematomas, and
• thrombosis.

In the case of open surgery via an abdominal incision, an incisional hernia may develop.

Foul-smelling flatulence and severe diarrhea—so-called steatorrhea—are not uncommon, especially in the first year after the procedure. Dumping syndrome may also occur if the chyme from the residual stomach enters the small intestine too quickly. This causes nausea, sweating, and circulatory problems. 

Rest and avoiding physical exertion are essential after surgery. Patients should also refrain from lifting anything weighing more than 5 kilograms.

High-fat foods are also off-limits, as they can worsen diarrhea. In addition, experts recommend eating several (up to six) small meals a day.

Recommendations for optimal follow-up care are generally tailored to the individual case. Patients should typically attend follow-up visits at the nutrition center and with their primary care physician.

To prevent the onset of deficiency symptoms, the targeted intake of

• fat-soluble vitamins,
• trace elements, and
• protein

may be advisable. The patient will also receive vitamin B12 in the form of injections for the rest of their life.

Foul-smelling flatulence can be alleviated with antibiotics, among other treatments. Decisions regarding their use and dosage are usually made by the attending physician.

Only a doctor can determine whether a biliopancreatic diversion is recommended in a specific case. A detailed consultation with the patient takes place before a decision is made. During this consultation, risks and, if applicable, alternatives are discussed.

In summary, the procedure undoubtedly offers very good prospects for success. Patients can expect a significant improvement in their quality of life.

If patients are experiencing severe distress, the potential negative consequences of a BPD seem comparatively minor. However, the final decision undoubtedly rests with the patients themselves, who must carefully weigh the pros and cons.