What is Biliopancreatic Diversion?
Biliopancreatic diversion surgery is a type of gastric bypass surgery that is not commonly performed on people, as it is more complicated and risky than the other gastric bypass procedures. A biliopancreatic diversion changes the normal process of digestion and allows food to bypass part of the small intestine which enables your body to absorb fewer calories. A common channel remains in which bile mixes with other pancreatic digestive juices before entering the colon. During surgery, a large portion of the stomach is cut out and removed to create a smaller stomach pouch, and then a part of the digestive system is re-routed so that food can bypass part of the small intestine. There are two types of biliopancreatic diversion surgeries: a biliopancreatic diversion and a biliopancreatic diversion with duodenal switch.
Because of the risks, this surgery is for people who are more than severely obese with a BMI of 50 or higher. It is done on people who want to lose weight but haven't been able to any other way - diet, exercise or medicine and this is creating serious health problems for them. In addition, biliopancreatic diversion patients should be prepared to make the necessary lifestyle changes that are required of bariatric surgery patients. This includes a commitment to a healthy lifestyle.
What Procedure is followed :
This surgery is a lot more complicated than other gastric bypass surgeries. There are a few pre-procedures you need to follow to ensure you are prepared for the actual surgery :
At the time of surgery, the area of surgery is often marked to avoid any errors. You will be administered with anaesthesia and will be asleep during the during the procedure. During the surgery a part of stomach will be cut out and removed. The remaining half will be connected to the lower portion of the small intestine. In the biliopancreatic diversion surgery with duodenal switch, an entirely different part of the stomach gets removed and the doctor leaves the pylorus intact. The pylorus is a valve that controls and coordinates food drainage from the stomach. These are done by making a large cut in the belly or by making a small cut and using small tools and a camera to guide the surgery.
You may need to stay in the hospital for 1 or more days after the surgery. The doctor will close the incision in your belly with staples or stitches. These will be removed 7 to 10 days after surgery, unless your doctor uses stitches that can dissolve. The incision will leave a scar that fades with time. You may take 3 to 5 weeks before you can get back to your usual routine. You will be given more specific instructions about your diet, exercise, and recovering from your surgery by your doctor.
Risk & Complication
There are many risks and complications involved with biliopancreatic diversion surgery including dumping syndrome, diarrhoea, nausea, shakiness, faintness, deficiency of iron, calcium, magnesium or vitamin b12, infection, stomach leakage into the abdominal cavity, peritonitis, deep being thrombosis, pulmonary embolism, gallstones, anaemia, osteoporosis, irregular bowel movements, and constipation. After the surgery you have to be careful about your diet. Your body will have difficulty in absorbing nutrients so you will have to reply on vitamin and mineral supplements.
Depending on how the surgery was done, you'll have to watch your activity during recovery. If you have had open surgery, avoid lifting heavy weights or doing strenuous exercise. In this case, you will probably be able to return to your normal routine in 4 to 6 weeks.
Your doctor will give you specific instructions about what to eat after the surgery. For about the first month after surgery, you should only consume amounts of soft foods and liquids while you are healing. It is important to try to sip water throughout the day to avoid dehydration.
Biliopancreatic diversion surgery typically ranges from $15,000 to $25,000. People who have this surgery must take vitamin and mineral supplements for the rest of their lives, which can be expensive.
A biliopancreatic diversion with duodenal switch is a less common kind of weight-loss procedure. The procedure is conducted in two steps. The first step involves sleeve gastrectomy, where about 80 percent of the stomach gets removed, hence leaving behind a small stomach, in the shape of a tube. Though the valve, which releases food to the small intestine remains intact along with a small portion of the small intestine that normally stays connected to the stomach. The second step ensures that the major part of the intestine gets bypassed through connecting the end portion of the intestine to the duodenum close to the stomach. A Biliopancreatic Diversion (BPD) puts a limit on how much one can eat and thus reduces the nutrients from getting absorbed, which includes fats and proteins.
BPD is usually conducted as a single procedure but in some selective situations, the procedure might get performed as two separate operations, sleeve gastrectomy and that is followed by intestinal bypass once the process of losing weight has begun.
Why the surgery is conducted?
A Duodenal Switch with Biliopancreatic Diversion is done in order to assist a person in losing excess weight and thus reduce the risk of developing potential life-threatening health problems related to health, which includes:
Eligible candidates for the surgery
Risks associated with the surgery
This particular surgery, as with any other surgery, carries some potential risks. They are both in the short-term and in the long-term.
Risks associated with BPD/DS are similar to any abdominal surgery and include:
Obesity is a serious lifestyle disorder that can trigger a myriad of health complications. You may often come across people who fail to lose an inch even after toiling hard. The situation may be further complicated and life-threatening if a person is suffering from diabetes, hypertension, arthritis or a heart problem. Bariatric Surgery comes as a much-needed relief for people who desperately need to lose weight to prevent health problems. People between 18-65 years of age can go for a Bariatric weight loss surgery. The surgery is also helpful for people with morbid obesity (a condition where the BMI is over 40) with associated complications.
Common types of Bariatric surgeries
Bariatric surgery is a procedure that involves modifications to the digestive system to restrict calorie intake or nutrient absorption by the body. These surgeries are usually recommended when lifestyle changes like exercise and diet may not cause the desired weight loss. In most such patients bariatric surgery can help lose 60% -100% excess weight within 1 year.
The various types of surgeries that come under this category are -
1. Gastric bypass – A common bariatric surgery, gastric bypass works through alteration of stomach size and re-routing of small intestine in a way that it leads to reduced consumption of calories. This procedure also causes alterations in the behavior of the gut hormones resulting in appetite reduction.
2. Sleeve gastrectomy – Commonest bariatric surgery, in this procedure almost 80% of the stomach area is removed surgically, which cause an overall reduction in the amount of calories consumed. This results in modification of gut hormones and altered gut bacteria linked with reduced appetite.
4. Biliopancreatic Diversion with Duodenal Switch - This procedure involves surgical removal of a large area of the stomach along with bypassing a major portion of the smaller intestine. This procedure may reduce fat absorption of up to 70%. The behavior of the gut hormones change resulting in a decrease in appetite and improved satiety.
Types of Weight Loss Surgeries-
1. Gastric Band
A band is put around stomach tightly which divides the stomach into two sections, namely smaller upper and larger lower which is connected through a small tube by which emptying of the upper part becomes slow. Since less food is required to fill this pouch; there is no need to eat much. The band is connected to a device under the skin. It can be tightened after 4-6 weeks after surgery.
Merits: Simpler method. Recovery is faster leaving a small scar.
In this procedure, a larger portion of the stomach is cut off, and the remaining smaller part is attached to the intestine. Smaller the stomach, lesser is the production of appetite-regulating hormone ghrelin. As a result, less food is taken in.
Merits: It is a simple method. As it does not involve intestines, the process of absorption takes place smoothly, and the patient does not fall short of nutrients.
Demerits: It is an irreversible process. It can cause infection and leaking of sleeve might take place.
3. Duodenal Switch with Biliopancreatic Diversion
In this procedure, a larger part (70%) of the stomach is cut off leaving the duodenum. The surgeon cuts the middle part of intestine attaches it to the duodenum. It is called duodenal switch. The leftover part of the intestine is again attached to the last part of intestine allowing pancreatic juices and bile to flow into that part. This is biliopancreatic division. Food passes directly into the small intestine limiting absorption of nutrients and calories, ultimately resulting in weight loss.
Merits: It is a fast method to lose weight, and the patient can eat large amounts of food.
Demerits: Nutritional deficiencies are seen.
4. Gastric Ballooning
A small balloon filled with salt and water is placed in the stomach through a thin tube via throat.Merits: The patient feels full and will not be able to eat much.
Demerits: It is a temporary method, which can last only for 6 months.
5. Gastric Bypass
In this procedure, the surgeon divides the stomach into two parts, namely upper and lower. Here, the upper part of the stomach is directly connected to the last part of the intestine.
Merits: More than 50% weight loss take place, as much weight gets reduced, and conditions, such as diabetes and blood pressure come under control.
Demerits: As less of nutrients are absorbed, the patient might land up into anemia and nutritional deficiency. The patient might need to take supplements after surgery to maintain balance. In case you have a concern or query you can always consult an expert & get answers to your questions!
Bariatric surgery is a procedure that involves modifications to the digestive system so that the food intake can be restricted or the nutrients absorbed by the body is reduced. This surgery is recommended when exercise and diet may not cause the desired results with weight loss. Bariatric surgeries is a group of surgeries that are procedure to reduce weight in the body.
The various types of surgeries that come under this category are
1. May cause infections in the body
2. Clots may form in the blood
3. It can result in bowel problems
4. Ulcers can form in the stomach
In case you have a concern or query you can always consult an expert & get answers to your questions!
What is Biliopancreatic Diversion?
What Procedure is followed :
Risk & Complication