A biliopancreatic diversion is one the types of bariatric surgery currently performed in the United States to treat obesity, along with adjustable gastric banding, gastric bypass, and sleeve gastrectomy. During a biliopancreatic diversion procedure, surgeons alter the normal digestive system, making the stomach smaller and directing the flow of ingested food to bypass about two-thirds of the small intestine. It is particularly indicated for super obese patients and it is the type of bariatric surgery that can result in greater weight loss, but it also has numerous risks.
The procedure consists of the removal of part of the stomach and reattachment of the remaining part to the lower portion of the small intestine. There are two methods to perform the surgery: biliopancreatic diversion and the biliopancreatic diversion with duodenal switch. The latter is the most common and it works in a different part of the stomach, leaving the pylorus valve, which is responsible for food drainage from the stomach, intact. After the surgery, the stomach is able to hold smaller amounts of food, while the body absorbs less nutrients and calories.
Recovery From a Biliopancreatic Diversion With Duodenal Switch Surgery
Undergoing biliopancreatic diversion with duodenal switch or to any other type of bariatric surgery is aggressive for the body and it needs time to heal. After the surgery, patients usually need to stay in the hospital for two or three days, during which physicians evaluate if the new digestive system works properly and if there are no staple leaks. It is normal for patients to experience abdominal pain during the first days. After going home, patients will have to wait at least two weeks before going back to work and will start on a special diet meant to help the stomach heal.
Right after the surgery, the stomach can only hold small amounts of soft food and liquids, and during the first months, patients carefully transition to solid foods according to their doctor’s recommendations. Starting at about four weeks after the surgery, patients will begin attending regular follow-up visits, which are usually every three months for the first year and semi-annual after that. Attending individual counseling and support groups is also recommended. Patients will feel full faster and with smaller amounts of food, but need to be attentive to symptoms like diarrhea, fainting, or nausea, which can be indicators of side effects like dumping syndrome and malnutrition.
Biliopancreatic Diversion With Duodenal Switch Recovery Compared to Other Procedures
According to the American Society for Metabolic and Bariatric Surgery (ASMBS), the biliopancreatic diversion with duodenal switch is the type of bariatric surgery able to cause best results, with 60 to 70% of excess weight loss or greater, at 5 year follow up. In addition, the society emphasizes as advantages that patients are able to eventually eat meals almost normal, while it reduces the absorption of fat by 70 percent or more. The procedure also causes favorable changes in gut hormones to reduce appetite and improve satiety and it is the most effective against diabetes, when compared to gastric bypass, sleeve gastrectomy and gastric banding.
However, there are also disadvantages associated with the procedure, which has higher complication rates and risk for mortality than any other procedure. Undergoing biliopancreatic diversion also requires a longer hospital stay. It has “a greater potential to cause protein deficiencies and long-term deficiencies in a number of vitamin and minerals, i.e. iron, calcium, zinc, fat-soluble vitamins such as vitamin D,” and “compliance with follow-up visits and care and strict adherence to dietary and vitamin supplementation guidelines are critical to avoiding serious complications from protein and certain vitamin deficiencies,” according to the ASMBS.
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