Biliopancreatic Diversion Surgery
Biliopancreatic diversion surgery is a type of gastric bypass surgery that is not commonly performed, as it is more complicated than the roux-en-y and mini gastric bypass procedures. The biliopancreatic diversion, along with its variation, biliopancreatic diversion with duodenal switch, is also associated with a greater risk of nutritional deficiencies after surgery. During surgery, a large portion of the stomach is removed to create a smaller stomach pouch, and then the digestive system is re-routed so food bypasses part of the small intestine.
Because this type of bariatric surgery is considered more risky than gastric banding procedures, biliopancreatic diversion is best suited to patients that are severely obese with a BMI of 50 or higher. 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.
- Anesthesia: Patients that undergo the biliopancreatic diversion procedure are put under general anesthesia.
- Incision: Biliopancreatic diversion is typically performed as an open, rather than laparascopic, surgery. This means that one large incision is required to open the stomach cavity.
- Creation of the pouch: Your surgeon will reduce the size of the stomach by about 85 percent. The remaining stomach pouch is larger than the one that is created during roux-en-y surgery, but will still restrict the amount of food and drink a patient can consume in one sitting.
- Division of the small intestine: After the stomach pouch is created, the small intestine is divided at the lower part of the small intestine; in roux-en-y surgery, the small intestine is bisected in its middle, rather than lower, area.
- Attachment of distal illium to new stomach pouch: The lower portion of the small intestine, the distal illium, is connected to the stomach pouch. This bypasses a portion of the digestive tract, meaning that the body absorbs fewer calories.
- Reattachment of the small intestines: The two sections of the small intestine are reattached near the large intestine, further down the digestive tract.
Duodenal switch is a variation of the biliopancreatic diversion procedure. In this technique, a larger portion of the stomach remains, including the pyloric valve and duodenum. In other gastric bypass procedures, the pyloric valve and duodenum are bypassed. The duodenal switch approach is intended to reduce the risk of dumping syndrome after surgery and allow for better absorption of vitamins and minerals by allowing some of the food to digest normally in the stomach before it moves into the small intestine. However, when compared to other weight loss surgery options, including gastric banding or roux-en-y surgery, duodenal switch surgery is generally considered to be a higher risk operation.
Following biliopancreatic diversion surgery, patients should stay home and rest for at least two weeks. During this time, patients should maintain an all-liquid diet to give the stomach time to heal. Your bariatric surgeon will provide you with dietary information before your procedure to help you avoid the unwanted side effects that are associated with biliopancreatic diversion surgery. As patients begin to feel better, they should attend individual counseling and support group sessions to help them maintain a positive outlook after surgery.
There are many risks associated with biliopancreatic diversion surgery, including:
- Dumping syndrome
- The body may have a more difficult time absorbing food and nutrients after this type of surgery; many patients have to rely on vitamins and supplements to avoid nutritional deficiencies
- Deficiency in iron, calcium, magnesium, or vitamin B12
- Stomach leakage into the abdominal cavity
- Deep vein thrombosis
- Pulmonary embolism
- Irregular bowel movements
Like other bariatric surgery procedures, biliopancreatic diversion surgery typically ranges from $15,000 to $25,000.
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