Biliopancreatic diversion presents a significant challenge, primarily in the postoperative care during the medium and long term, rather than posing a high surgical risk. The fundamental diversion continues throughout a person’s life, ensuring effective weight maintenance but also raising the possibility of enduring nutritional concerns. As a result, biliopancreatic diversion is recommended for individuals who:

1. Have undergone previous obesity surgery without achieving weight loss success.
2. Experience severe metabolic complications of obesity, such as severe diabetes and/or hypercholesterolemia.
3. Are unwilling to abandon their natural relationship with food, particularly those hesitant to adopt a restrained eating approach even without significant effort.
4. To undergo biliopancreatic diversion, individuals must adhere to a protein-rich diet (including meat, fish, eggs, cured meats, and cheeses) and should not have intestinal problems or conditions resulting in reduced absorption.

There are no specific preparation rules for Biliopancreatic Diversion.

The Biliopancreatic Diversion (BPD) involves two steps: firstly, a distal gastric resection is performed, which entails the removal of approximately two-thirds of the stomach, including the pylorus. Subsequently, the actual Biliopancreatic Diversion is carried out, creating a double intestinal conduit to delay the encounter between ingested food and digestive juices. This method divides the small intestine into two tubes: one for the passage of food and the other for biliopancreatic secretions from the liver and pancreas. The meeting between juices and food occurs only for a short distance, 70 centimeters from the colon.

During the biliopancreatic diversion with duodenal switch (BPD-DS) a different part of the stomach is removed and the surgeon leaves the pylorus intact.

This prolonged separation results in reduced digestion and, consequently, lower absorption of nutrients; a particularly significant advantage in the case of the intake of fats and starchy foods with a considerable caloric content.

After the surgery, it is crucial to undergo follow-up visits and the prescribed blood tests to ensure that the diet is adequate and that the supplements are sufficient. The post-operative dietary regimen should include large quantities of proteins, found in meat, fish, eggs, processed meats, and cheeses. Additionally, the patient will be encouraged to take oral supplements of calcium, iron, and vitamins for life (not all of which are available through the National Health Service).

However, nutritional follow-up can fail due to a lack of patient cooperation or excessive malabsorption. In such cases, complications such as anemia, osteoporosis, vitamin deficiencies, and protein malnutrition may arise. In the event of chronicization of these complications or intolerance to side effects (especially those affecting the intestine), there may be an indication for a revision of Biliopancreatic Diversion. Through a new surgical intervention, it can be made less aggressive, reversed, or transformed into another procedure.”

Following biliopancreatic diversion, there is a weight loss of approximately 70% of excess pounds on average within 12-18 months. This method aids in weight loss without requiring a strict dietary regimen. After the procedure, patients can have a much more lenient diet compared to other methods. However, careful control of simple sugar intake (found in fruit, sweets, milk, soft drinks, and alcohol) is necessary, as its absorption is not altered by biliopancreatic diversion.

Biliopancreatic diversion is the most effective intervention available to us against obesity complicated by diabetes and hypercholesterolemia.

Your doctor will provide clear guidelines on your post-surgery diet. In the initial month following the procedure, your stomach’s capacity for food is limited to small portions of soft foods and liquids to facilitate the healing process. Maintaining hydration is crucial during this period, so make an effort to sip water throughout the day to prevent dehydration.

It’s normal to experience irregular bowel movements immediately after surgery. To mitigate this, it’s advisable to steer clear of constipation and avoid straining during bowel movements.

Surgical complications can be immediate, common to all general surgery procedures, or delayed. The latter may be surgical in nature (ulcer, intestinal obstruction from adhesions, laparocele, which is a hernia at the surgical incision site) or nutritional.

Late nutritional complications are particularly significant and result from reduced absorption. These include anemia, osteoporosis, vitamin deficiencies, and protein malnutrition. The surgery also leads to an increase in bowel movements, which can be particularly odorous, along with phenomena of flatulence. The frequent bowel movements may contribute to the onset of hemorrhoids or other perianal pathologies.