The Biliopancreatic Diversion (BPD)
Weight Loss Surgery Procedure

Introduction to the Biliopancreatic Diversion Procedure (BPD)

The weight losses achieved by this procedure have been reported to be the best for any available weight loss procedure. Weight regain is also less likely to occur because of the inability to absorb more than 25% of ingested fat and starch.  The BPD, like the DS is a more advanced bariatric operation compared to the Bypass or Lap-Band, and can be done open or laparoscopically.  We perform the Biliopancreatic Diversion Laparoscopically, and at present our Weight Loss Surgery Program is the only one in Kansas, and several states around the area performing the Biliopancreatic Diversion.

The Biliopancreatic Diversion works by malabsorption and restriction.  The majority of the stomach is removed, and the small intestine is re-arranged to induce a large degree of malabsorption by delaying the point where the digestive enzymes meet with the food.  The last 50-100 cm of small intestine is where the food is allowed to mix with the digestive enzymes, thus allowing digestion and absorption to begin.  The length of the small bowel can be increased or decreased to change the degree of malabsorption. 

While these operations remove a large part of the original stomach, the stomach pouch created is larger than with the bypass or lap-band. Many patients find this attractive about the operation because they can eat relatively normally once the stomach has recovered, as opposed to the gastric bypass. Though restriction contributes to weight loss, the operation mostly relies on altering the normal digestive process by inducing malabsorption for weight loss.  The absorption of food and calories is reduced to a much greater degree than with the bypass. The surgeon is able to vary the length of the common limb (50 to 100 cm) to regulate the amount of absorption of protein, carbohydrates, fat and fat-soluble vitamins. 

The Laparoscopic BPD is especially good if you have a great deal of weight to lose, and if you have insulin-dependent diabetes, high triglyceride levels in the blood, and hypertension.  In many cases the weight loss with the lap-band or bypass may not be enough to get many patients out of the Morbidly Obese BMI range, and to improve or cure their medical problems.  The BPD has a higher average weight loss of 80 to 85%, what some patients need to reach for a more normal BMI range.   Professor Scopinaro, the foremost authority on the BPD, claims a long-term (greater than 10 years) weight loss of 73%.

Proceeding with weight loss surgery is a very personal and often difficult decision.  Educating yourself about weight loss surgery is a very important first step.  Although the information presented here may be very helpful, patients have repeatedly told us that attending the weight loss surgery informational seminar helped the most.

For those of you who are not from Kansas, we treat many patients from out-of-state, and from all across the United States.  When contacting the office please inform the staff that you are traveling from out-of-state and access our out-of-state link for more information on how we can help you with the preparatory process.

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Am I a Candidate for the Biliopancreatic Diversion (BPD)?

To be a candidate for any type of weight loss surgery, the individual must be morbidly obese.  Below are tools you can use to determine if you are morbidly obese and potentially a candidate for the Biliopancreatic Diversion. If you determine you are morbidly obese you are a candidate for the Biliopancreatic Diversion.

Morbid obesity is usually defined as being 100 pounds over the ideal body weight. A better way of defining morbid obesity is by using the Body Mass Index (BMI). BMI is a calculated number that takes weight and height into consideration. A person weighing 300 pounds that is 5ft tall will have a higher BMI than a person weighing 300 pounds but is 6ft tall.  A BMI above 40 indicates that a person is severely obese and therefore a candidate for surgery. Surgery may also be an option for people with a BMI between 35 and 40 who already suffer from cardiopulmonary problems or diabetes.

You are likely morbidly obese if you:

• Are more than 100 lbs. over your ideal body weight, or have a Body Mass Index (BMI) of over 40
• Have a BMI 35 or greater and are experiencing severe negative health effects of co-morbidities, such as high blood pressure, diabetes, etc. related to being severely overweight
• Are unable to achieve a healthy body weight for a sustained period of time, even through medically supervised dieting
• Have physical, psychological, social, or economic problems that could be significantly improved by weight loss

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The Biliopancreatic Diversion Procedure (BPD)

The Biliopancreatic Diversion works by malabsorption and restriction.  The majority of the stomach - about 3/4 - is removed, to produce both restriction of food intake and reduction of acid output. The stomach or pouch that is left is about 250 to 400cc in size, without preservation of the pyloric valve.  Leaving enough upper stomach is important to maintain proper nutrition. The small intestine is then re-arranged to induce a large degree of malabsorption by delaying the point where the digestive enzymes meet with the food.  The "alimentary limb" is the intestine that carries the food from the stomach. The ‘Biliopancreatic Limb” leading from the gallbladder and pancreatic ducts carries the digestive enzymes to the alimentary limb at about 50-100 cm from the ileo-cecal valve.  The last 50-100 cm of small intestine is where the food mixes with the digestive juices and is called the "common channel".  The length of the common channel can increase or reduce the degree of malabsorption.  The most important feature of the BPD is that it diverts your food stream so that it is only in the last 50-100 cm, the "common channel", that your food can mix with your digestive juices, in order to start digestion and absorption of food.  Very similar to the DS.

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How Does the Biliopancreatic Diversion (BPD) Work?

The BPD is mostly a malabsorptive procedure.  During the initial 6 to 12 months it does rely on restriction from the newly created pouch for additional weight loss.  The operation induces weight loss by restricting how much food is eaten, as well as by reducing how much of that food is absorbed.  The shorter the common channel the less food will be digested and less food will be absorbed.  Eventually patients will be able to consume reasonable amounts of food, which for many is an attractive feature. 

The effect of the procedure is threefold:

• The patient is initially only able to eat a very small amount of food. As time progresses, usually by 12 months from the time of surgery, the patient will be able to consume regular-sized meals.
• The food passes through only 40% (275cm) of the small bowel and so reaches the colon much more rapidly than normally and so has less time to digest fully.
• The bile from the liver and the pancreatic juice from the pancreas, two of the most important digestive juices, have only 1/10 of the normal time to digest the food in the small bowel as they enter the bowel only 50 to 100 cm from the cecum. This results in failure to break down fats, starches and proteins so that they absorb poorly. Only approximately 25% of these are absorbed. This means there is a major alteration in the patient’s digestive processes with controlled mal-absorption of nutrients. The poorly digested food passes rapidly through the colon and is lost to the system with significant resultant initial weight loss and maintained long term weight control. 

To learn more about how the Biliopancreatic Diversion operation will change your eating habits, impact on your nutrition and more, please access our BPD Diet Guide for more information.

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Advantages of the Biliopancreatic Diversion Weight Loss Surgery

• BPD has the highest rate of type 2 diabetes resolution of all the different bariatric surgery procedures: 98.9 percent cure rates have been reported.
• BPD has the highest rate of hyperlipidemia resolution: 99.1 percent cure rates have been reported.
• 75.1 percent of hypertension cases have been reported to be resolved or improved.
• 91.9 percent of sleep apnea cases have been reported to be resolved.
• Excess weight loss is roughly 73 percent long term, at 10 years out.
• These operations often result in a high degree of patient satisfaction because patients are able to eat larger meals than with a purely restrictive or standard Roux-en-Y gastric bypass procedure.
• These procedures can produce the greatest weight loss because they have the highest rates of malabsorption.
• Long-term maintenance of excess body weight loss can be successful if the patient adjusts to and maintains an easy-to-follow dietary, supplement, and behavioral routine.
• As with every type of bariatric surgery, the overall quality of life for patients improves greatly. A great deal of excess weight is lost, and patients experience resolution of co-morbidities, and improved appearance, social opportunities, and economic opportunities.

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Risks of the Biliopancreatic Diversion Weight Loss Surgery (BPD)

• There is a period when the intestines adjust and bowel movements can be very liquid and frequent. This condition will lessen over time, but may be a lifelong condition.
• Abdominal bloating and foul-smelling stool or gas may occur.
• Patients, surgeon and their primary care physicians should monitor for protein malnutrition, anemia, and bone disease throughout the patient’s life. Patients also need to take vitamin supplements for the rest of their lives. Not taking either of these precautions can lead to health issues that require treatment. In fact, it’s been found that if patients do not follow eating and vitamin supplement instructions closely, at least 25 percent will develop problems that require treatment.
• Changes to the intestinal structure can increase the risk of forming gallstones and the need for removal of the gallbladder.
• Patients should be aware of the possibilities of intestinal irritation and ulcers.
• Prof. Scopinaro has reported excellent long-term weight control over a ten year follow-up. Additional benefits include control of weight-related co-morbidities such as diabetes, sleep apnoea, arthritis and the reduction of raised cholesterol and triglyceride levels to normal.
• After one year there is compensatory enlargement of the stomach and small bowel that allows weight loss to stabilize. Enough mal-absorption remains to prevent major weight regain in most cases.
  It is necessary to take a number of nutritional supplements after the operation. These include:
  • Multivitamins (usually twice per day)
  • Iron supplements (usually twice per day)
  • Calcium (usually twice per day)
  • ADEKs (fat-soluble vitamins) usually 3 times per day
• Additionally, there are some very significant side effects that accompany this procedure, including:
  • Frequent soft bowel movements (up to 4-6 per day)
  • Frequent passing of foul-smelling gas
  • Change in body odor
  • Gas pains and bloating
  • Hair loss
  • Intolerance of certain foods (varies from person to person)
• The main complications at the time of surgery are:
  • leakage of the anastomoses between stomach and intestine resulting in abscesses or peritonitis
  • haemorrhage
  • pulmonary embolism
  • myocardial infarction
  • pneumonia
  • pancreatitis
• Late complications and side effects include:
  • vitamin deficiencies
  • calcium deficiency resulting in bone softening
  • protein malnutrition
  • diarrhoea
  • malodorous bowel motions and flatus
  • small bowel adhesions

The possible problems experienced with the operation are mostly malabsorptive in nature, but most can be managed when they occur by taking supplements. The major complication to worry about with this operation in the long-term is protein malabsorption.  If patients are being followed appropriately, this is usually caught early, and can be managed very well with adjustment of the type and quality of protein the patient is consuming, the addition of pancreatic enzymes, and then if necessary, surgical lengthening of the common channel to improve absorption. Malabsorption of the fat-soluble vitamins, Vitamins A, D, E and K, are also potentially at risk, and these must be followed as well. Prolonged, uncorrected deficiencies of these Vitamins can be very serious, leading to problems such as night blindness (Vitamin A deficiency) and immune system compromise (Vitamin E deficiency). These can also be managed well with supplements if the deficiency can be caught early.  A more complete list of the potential risk and benefits of weight loss surgery operations is provided for you by the Risks and Benefits link

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Deciding on the Biliopancreatic Diversion Weight Loss Procedure

The DS has a greater weight loss than the Lap-Band or Bypass.  The DS takes advantage of major malabsorption as well as restriction.  It relies on restriction for initial weight loss, and on malabsorption for continued weight loss and maintenance.  The BPD is also a “bigger” operation than the gastric bypass with potentially more risks.  Since the stomach pouch is larger than with other bariatric operations, you can eat larger portions than with the gastric bypass or lap-band.

The decision about which operation is best for you is a complicated one. Although the information presented here may be helpful, you will be able to learn substantially more about the benefits and risks of the BPD operation during your consultation with the bariatric surgeon or at our free weight loss surgery informational seminars. To register for the seminar or arrange an appointment call (913) 322-7401.

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IABS Weight Loss Surgery Program in Kansas City

Our surgeons want to meet with you on a regular basis particularly during the first and second year when rapid weight loss occurs.  Your primary care doctor is also a very important extension of your post-operative care.  As you start losing weight your medical problems will start improving and you may not require the same dose of your medications.  Together we monitor and adjust your need for medication. 

The long-term side effects of weight loss surgery can be subtle, and can appear months to years after the surgery. As mentioned above, nutritional and vitamin deficiencies are possible, but are successfully managed with supplements. Protein malnutrition is potentially a major problem, but it is rare with proper follow-up.

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The Next Step - sign up for the IABS Weight Loss Surgery Seminars

Proceeding with weight loss surgery is a very personal and often difficult decision.  Educating yourself about weight loss surgery is a very important first step.  Although the information presented here may be very helpful, patients have repeatedly told us that attending the weight loss surgery informational seminar helped them the most.  At the seminar you will be able to separate fact from fiction, meet the surgeons, ask questions, and hear testimonials from patients who have already undergone weight loss surgery. The patient testimonials are often the highlight of the seminar.  Individuals considering weight loss surgery enjoy talking to patients and getting first hand accounts of how the operations have worked for them and how it has changed their lives. 

The next step is to meet in consultation with the surgeon.  The visit has multiple purposes:  determine your health and operative risk, discuss which operation may be best for you, answer your specific questions and concerns, and start the preparatory process toward getting insurance pre-approval and scheduling your surgery.  You can save about 45 minutes of your time at the doctor’s office by filling out the New Patient Forms prior to coming for your doctor consultation.

While waiting for your insurance approval, or obtaining your medical work-up start reading the Preparatory Guide and the BPD Diet Guide.  These will prepare you for your surgery as well as what to expect after your operation.  For further questions do not hesitate to contact the office at (913) 322-7401.

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