Bilio Digestive Pancreatic Diversion
Principle of Bilio Pancreatic Diversion
Biliopancreatic diversion was a development on the jejunoileal bypass type of bariatric surgery. It can be performed with or without a duodenal switch.
The procedure involves:
Distal gastrectomy, with gastric pouch formation
Gastroenterostomy, with formation of a Roux limb of approximately 250 cm (the normal small intestine is about 550 cm long)
Anastomosis of the biliopancreatic limb to the Roux limb ~ 50 cm upstream of the valve ileocecal
The postgastrectomy syndrome led to the development of a variant duodenal switch. In this variation, the stomach is restricted along the greater curvature (like a sleeve gastrectomy) and the shortened Roux's limb is attached end-to-end to the proximal duodenum. The biliopancreatic limb is attached similarly to the normal biliopancreatic diversion.
Treatment and prognosis
Biliopancreatic diversion has been reported to result in 70% long-term weight loss in over 90% of patients. The duodenal switch variant may be even more effective. These procedures can sometimes be used when other more conservative bariatric procedures have failed.
Complications
Although the procedure avoids bypass enteritis from jejunoileal bypass (with an associated risk of liver failure), it has a number of side effects, including:
Risk of nutritional deficiency: calcium, fat-soluble vitamins and proteins.
Postgastrectomy syndrome: marginal ulcers and dumping syndrome. Decreased with duodenal change.
Intestinal obstruction, internal hernia, anastomotic leak.
What patients is it for?
The official entry of the biliopancreatic diversion into the surgical arsenal was accompanied by restrictions. In particular, in first intention, the body mass index must be at least 50 kg/m2. Somewhat curiously, in the event of failure of a previous obesity surgery, the BMI restriction disappears. In any case, it must be noted that most of the published series concern a population with a BMI ≥ 50 and the nutritional risks associated with this surgery probably justify this attitude. It is quite clear that biliopancreatic diversion is an operation that leads not only to more intense weight loss but also to a lower risk of weight regain than gastric bypass in patients whose BMI is greater than 50. however, there is no comparison for lower BMIs and all of these studies are retrospective in nature.
