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Disadvantages: Biliopancreatic Diversion (BD)

From the patient’s perspective, the great advantages of the biliopancreatic diversion are the ability to eat large quantities of food and still achieve excellent, long term weight loss results. But aside from the many benefits of BD, it should be underlined that this procedure is one of the most complex and comprehensive operations in bariatric medicine. The possible disadvantages cannot be overlooked.

One such disadvantage to having a BD is the post-operative maintenance and the lifelong observation involved. And more often than not, you could be living with an uncompromising foe in the form of loose stools, stomal ulcers, offensive body odor and foul smelling stools and flatus.

The most serious potential complication is protein malnutrition, which is associated with, anemia – a condition that generally requires hospitalization. BPD patients need to take supplemental calcium and vitamins, particularly Vitamin D, lifelong. Because of this potential for significant complications, BPD patients require lifelong follow-up. In BPD patients who have received 200 - 300 cm alimentary limbs because of protein malnutrition concerns, the incidence of protein malnutrition fell dramatically to range from 0.8% to 2.3%

Variants of this operation have been devised in an attempt to reduce the incidence of stomal ulceration and diarrhea using the techniques of sleeve resection of the stomach which maintains continuity of the gastric lesser curve and duodenal switch which maintains continuity of the gastro-duodeno-jejunal axis.(Marceau, Biron et al. 1993) This technique essentially eliminates stomal ulcer and dumping syndrome.

BPD and its variants are the most major procedures performed for obesity and it follows that prospective patients who wish to consider BPD should seek out experienced surgeons with life-long follow up programs.

Additionally, some lifestyle changes will have to be made after the BPD procedure. You will only be able to have small portions of food. You may even have to remind yourself to eat because you will not have much of an appetite - especially initially. Many patients’ taste for foods completely changes. You will have to re-learn what foods taste good to you and which ones do not upset your stomach. Patient with a BPD generally have less difficulty than patients with a RNY gastric bypass. This is because their stomach is bigger and there is no dumping syndrome.

Because the BPD bypasses so much intestine, the ability to absorb some minerals is impaired. As mentioned above, most people will never develop any significant vitamin deficiencies. Lifelong vitamin supplementation is necessary to prevent severe anemia, bone loss and nerve problems. Because we bypass much of the small intestine and the breakdown of protein requires both pancreatic juice as well as stomach acid, the absorption of proteins may be significantly impaired. We can measure the protein stores in patients by checking an albumin level in the blood. Normal is greater than 3.5. Levels below 2.5 require intensive protein supplementation orally.

Risks common to all surgeries for weight loss include an infection in the incision, a leak from the stomach into the abdominal cavity or where the intestine is connected and a blockage of blood flow within the lung. About one-third of all people having surgery for obesity develop gallstones or a nutritional deficiency condition such as anemia and osteoporosis.