Biliopancreatic diversion is one of the four main types of bariatric surgery conducted in the United States. The procedure is the least common compared to the other types of weight loss surgery, which include gastric bypass, adjustable gastric banding, and sleeve gastrectomy. One of the reasons for its limited use is the fact that it is specifically recommended for morbidly obese patients, the equivalent to having a Body Mass Index (BMI) higher than 50. Prior to deciding on biliopancreatic diversion or another type of bariatric surgery, patients need to take into consideration the surgery’s success rate and risks associated with it.
During the procedure, surgeons alter the normal digestive system by reducing the size of the stomach and reconnecting it to the small intestine, which makes food bypass part of the small intestine. There are two different methods used in conduct biliopancreatic diversion surgery. For the first method, part of the stomach is removed, while the remaining part is connected to the lower portion of the small intestine. In a biliopancreatic diversion with duodenal switch — the most common procedure — a different part of the stomach is removed, leaving the pylorus — the valve responsible for controlling food drainage from the stomach — untouched.
Biliopancreatic Diversion Success After Surgery
Since it is an invasive surgery, the results of biliopancreatic diversion are still a topic of debate. While weight loss is not automatic after surgery and patients need to commit to behavioral alterations for it to be a success, there are success parameters that can be evaluated right after the surgery. The study “The Duodenal Switch Operation for the Treatment of Morbid Obesity” analyzed the results of the surgery in 701 patients and demonstrated that 1.4% of them died while at the hospital or 30 days after the surgery, the most common causes of death being pulmonary embolus, rhabdomyolysis, duodenal stump leak, gastric leak, cecal necrosis, and aspiration pneumonia.
Male gender, older age, and higher preoperative BMI were significantly associated with perioperative mortality, explained the authors. In addition, other significant occurrences are worth noting, including nonfatal leaks that occurred at the site of the duodenoenteric anastomosis, the enteroenterostomy anastomosis, duodenal stump, and at the gastric staple line. Due to complications, patients may need to be submitted to splenectomy procedures, postoperative exploratory laparotomies, revisional surgery, or reoperation. However, a small percentage of patients suffer these types of problems, and the success rate of the surgery remains high overall.
Long-Term Impact of Biliopancreatic Diversion
While the sucess of the surgery is closely related to the skill of the medical team, the long-term success of the treatment following a biliopancreatic diversion surgery is more associated with patients’ behavioral changes. After the surgery, the patient will continue to be followed by physicians and dietitians for years, and will have to adopt new habits regarding a healthy diet and physical activity. The study “Biliopancreatic Diversion: The Effectiveness of Duodenal Switch and Its Limitations” revealed the success of patients submitted to biliopancreatic diversion in achieving and maintaining significant weight loss.
After two years, patients had lost an average of 73% excessive weight, making it the most effective type of bariatric surgery regarding weight loss. Patients submitted to gastric bypass lost 63%, in the case of sleeve gastrectomy 56%, and gastric banding 49%, in the same period. “Biliopancreatic diversion (BPD) produces the most significant weight loss with amelioration of many obesity-related comorbidities compared to other bariatric surgeries; however perioperative morbidity and mortality associated with this surgery are not insignificant; additionally long-term complications including undesirable gastrointestinal side effects and metabolic derangements cannot be ignored,” added the study authors.