Bilipancreatic diversion is one of four types of bariatric or weight loss surgery conducted in the United States to help patients struggling with obesity. Bariatric surgery is usually the last option for obese or morbidly obese patients who have tried but failed to lose weight with other medically-supervised weight loss programs. While bariatric surgery is recommended for patients with a Body Mass Index (BMI) higher than 40 or 35 and associated comorbidities, in the case of bilipancreatic diversion, which is particularly indicated for super obese patients, the equivalent to a BMI higher than 50 is required.

During the procedure, surgeons cut part of the stomach and reattach it to the small instestine, which results in a reduction of the size of the organ and rearrangement of the digestive system. There are two ways of performing the surgery, with biliopancreatic diversion when part of the stomach is removed and the remaining part connected to the lower portion of the small intestine. The biliopancreatic diversion with duodenal switch is the most common method and consists of the removal of a different part of stomach, leaving the pylorus valve, which is responsible for food drainage from the stomach.

Biliopancreatic Diversion Surgical Risks

Despite the results of the surgery in weight loss, there are also risks associated with it. The fact that a patient is submitted to a surgery can already comprise risks, including infection in the incision, a leak from the stomach into the abdominal cavity or into the connection between the stomach and the intestine, which can cause an infection known as peritonitis, as well as blood clots in the legs, deep vein thrombosis (DVT) or in the lungs, known as pulmonary embolism. In addition, patients may also develop gallstones or nutritional deficiencies like anemia or osteoporisis right after the surgery. According to the study “Biliopancreatic Diversion: The Effectiveness of Duodenal Switch and Its Limitations,” mortality during the surgery or up to 30 days following it has decreased from 6.1% to 4.9% to 2.1% in 2003, 2008, and 2011, respectively.

Long-Term Risks After Biliopancreatic Diversion

“It is important to acknowledge that BPD/DS is the procedure of choice for the most extremely obese patients; therefore it can be assumed that surgical risk in this group is higher at baseline,” explain the authors of the study, who highlight the most relevant risks associated with the surgery. One-year complication rates occur in 25.7% of the patients and include minor complications such as gastrointestinal side effects, flatulence, malodorous stools, and steatorrhea, as well as major complications, like gastrointestinal anastomotic leak, dumping syndrome, malnutrition, iron-deficiency, protein calorie malnutrition, hypocalcemia, and deficiency of fat soluble vitamins, vitamin B1, vitamin B12, and folate.

How to Address Biliopancreatic Diversion Risks

This type of surgery is considered high risk, and physicians often attempt to help patients avoid side effects even before the surgery is performed. Since there are other types of bariatric surgery, patients and surgeons should discuss all options before deciding, and which one is more indicated for the patient’s characteristics. In addition, choosing accredited and experienced clinics and surgeons can help reduce the risks. Following the surgery, patients will have to commit to behavioral alterations and will need to take vitamins and mineral supplements for the rest of their lives. Following the medical team’s recommendations is another important step. In the case of the development of severe side effects, patients may need to be submitted to additional treatments or surgeries.

Biliopancreatic Diversion Risks Compared to Efficacy

Biliopancreatic diversion is the most effective bariatric surgery in achieving and maintaining weight loss, as it can result in 73% of excessive weight loss at the two-year follow-up after surgery. However, the comparison between risks and benefits leaves doubts about its use among medical professionals. “Current evidence suggests that BPD/DS produces the greatest weight loss in obese individuals with the most significant improvement in obesity-related comorbidities. However, the utilization of this bariatric surgical procedure is limited compared to other surgical options. The technical complexity of BPD/DS and lack of knowledge may only partly explain the decreased utilization by surgeons. Concern regarding severe metabolic disturbances and malnutrition may also be implicated,” explained the authors.

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