What is biliopancreatic diversion?
Biliopancreatic diversion aims to postpone the meeting of the digestive juices and food ingested in order to reduce the digestion and thus the absorption of food. Biliopancreatic diversion is a method that results from Italian research: the first intervention was in fact completed at the University of Genoa in 1976.
How is biliopancreatic diversion performed?
Biliopancreatic diversion involves two steps: First a distal gastric resection is made, or the removal of about two-thirds of the stomach, pylorus included. It then proceeds to the biliopancreatic diversion itself, which is done by creating a double intestinal canal to delay the meeting between ingested food and digestive juices. This method divides the small intestine into two tubes: one is used to pass in foods and the biliopancreatic tube passes secretions from the liver and pancreas. The meeting between digestive juices and food is only for a short distance, located 70 cm from the colon. The separation of the small intestine leads to a reduced digestion and therefore a lower absorption of food. This is a particularly important advantage in the case of intake of fat and flour.
What are the advantages of biliopancreatic diversion?
Biliopancreatic diversion leads to a drop in weight equal to a loss of about 70% of the excess pounds in 12-18 months. This method helps in weight loss while not requiring a restricted diet. Following the intervention the patient will have a much more free diet than that provided by other methods. This will require a careful control of the intake of simple sugar (found in fruits, sweets, milk, soft drinks and alcohol), whose absorption is not affected by biliopancreatic diversion. The biliopancreatic diversion is the most effective intervention available against obesity complicated by diabetes and hypercholesterolemia.
Is biliopancreatic diversion painful or dangerous?
The complications of this surgery are common to all general surgery, and they may or may not be immediate. The complications that occur later on (ulcer, bowel obstruction from adhesions, incisional hernia or incisional surgical wound) can be surgically treated or treated through nutritional methods.
The nutritional complications are particularly important and they are a consequence of reduced absorption. These include anemia, osteoporosis, vitamin deficiencies, protein deficiencies and malnutrition. The intervention also causes an increase in bowel movements, which will be particularly smelly along with an increase in intestinal gas. Frequent release can promote the onset of haemorrhoids or other perianal diseases.
Which patients can undergo biliopancreatic diversion?
Biliopancreatic diversion is a challenging surgery, not so much with regard to the surgical risk as to the postoperative management in the long term. The diversion is aimed to improve basic functions for life, and therefore has good results on the maintenance of weight lost but at the same time it may cause lifelong nutritional problems.
We recommend the diversion surgery to patients who:
- Have already performed surgery for obesity but have failed in weight loss
- Have severe metabolic complications of obesity, a severe form of diabetes and/or hypercholesterolemia
- Cannot accept to give up their natural relationship with food
- Have a diet that includes a good amount of protein (meat, fish, eggs, sausages, cheese) and do not suffer from bowel problems or they are not suffering from intestinal diseases resulting in reduced absorption.
After surgery it is essential to undergo check-ups and blood tests in order to verify that the energy is adequate and that supplements are sufficient. The post-operative diet should provide large amounts of protein (meat, fish, eggs, sausages and cheese). The patient will also be invited to take on lifelong oral supplements of calcium, iron and vitamins (not all are purchased through the National Health Service).
The nutritional follow-up can fail for a lack of cooperation of the patient, such as for excess malabsorption. In this case there may be complications such as anemia, osteoporosis, vitamin deficiencies, protein malnutrition, and in case of chronicity of these complications or intolerance to side effects (especially those on the intestine) can indicate a revision of biliopancreatic diversion. With a new surgery it can be made less aggressive, it may be corrected as it was before or it may be converted into another intervention.
The biliopancreatic diversion does not require any special preparations.