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Advantages: Biliopancreatic Diversion (BD)

Malabsorptive operations, such as biliopancreatic diversion(BPD), restrict both food intake and the amount of calories and nutrients the body absorbs.

In a BPD procedure, portions of the stomach are removed. The small pouch that remains is connected directly to the final segment of the small intestine, completely bypassing the duodenum and the jejunum. A common channel remains in which bile and pancreatic digestive juices mix prior to entering the colon. Weight loss occurs since most of the calories and nutrients are routed into the colon where they are not absorbed.

This procedure is less food restrictive than the Roux-en-Y (RNY) operation. The stomach capacity is 4-5 ounces compared with RNY of around an ounce. There is a significant malabsorptive component which acts to maintain weight loss long term.

Other benefits include long-term health benefits like an improved cardiovascular system. According to one case, documented by PubMedCentral, A 56-year-old man with severe clinical obesity underwent a biliopancreatic diversion with a duodenal switch after unsuccessful treatment with weight loss pharmacotherapy.

He had diabetes, hypertension and sleep apnea syndrome and was on three medications for hypertension and two hypoglycemic agents in addition to more than 200 insulin units daily. Eleven months after the surgery, he had lost 40% of his body weight. The lipid profile showed great improvement and the hypertension and diabetes were more easily controlled with no more insulin needed. Additionally, the pseudo-normalized pattern of his heart functions improved and ventricular walls showed decreased thickness.

In short, the man had an improved cardiovascular system that helped control his diabetic condition and stabilize his blood pressure.

In most other instances, patients who undergo biliopancreatic diversion experience:

  • significant malabsorptive component
  • better chance of sustained weight loss
  • ability to eat larger quantities of food and still lose weight
  • more "normal"  absorption of many nutrients than with RNY, including calcium, iron and vitamin B12
  • better eating quality when compared to other WLS procedures
  • essentially eliminates stomal ulcer and dumping syndrome