What Is Biliopancreatic Diversion Bypass (BPD)?

BPD (Scopinaro procedure) is a type of gastric bypass to treat severe clinical obesity. Biliopancreatic Diversion combines a certain amount of restriction with a high degree of malabsorption, and was originally designed to reduce the health complications associated with the discontinued jejuno-ileal bypass procedure. Although it produces excellent weight loss results, and permits patients to eat a larger amount of food than after most bypass operations, BPD is less common nowadays because BPD patients require long-term nutritional follow-up to prevent post-operative malnutrition. Bariatric surgeons prefer the Roux-en-Y Stomach Bypass to BPD, although the improved Duodenal Switch Gastric Bypass has its advocates.

How Does Biliopancreatic Diversion Bypass Work?

Like all modern gastric bypass operations, BPD aims to restrict food intake by reducing the size of the stomach. This “restrictive” element of the operation is achieved by the surgical removal of part of the stomach. In addition, it aims to reduce the nutrients and calories which can be absorbed from this restricted food intake. This “malabsorption” element is achieved by bypassing both the duodenum and jejunum of the small intestine and taking food from the stomach directly to the lower (distal) part of the digestive tract. This bypass reduces the length of functioning small intestine (where most nutritional uptake occurs) so that a significant amount of fat and other macronutrients pass through undigested through the digestive system. It is this malabsorptive element of the BPD operation that accounts for the very high rate of weight reduction.

What Happens During A Biliopancreatic Diversion Bypass Operation?

First, using gastric staples, a pouch of the upper (proximal) stomach is created approximately 200 ml (6 oz) in size. (After Roux-en-Y gastric bypass the stomach is roughly 30 ml in capacity.) The distal stomach is then removed from the body. Second, the surgeon connects the stomach (by anastomosis) to the ileum (the final section of the small intestine) at a point roughly 2-4 feet above the colon. The proximal small intestine (duodenum), which receives biliary and pancreatic secretions, is then attached to the last 50 cm of small intestine, allowing these digestive substances to mix with food from the stomach in a “common channel” comprising only the last 20 inches of ileum. This reduction in digestive capacity means that BPD patients are unable to digest much of the food they eat. The bariatric surgeon is able to modify the severity of both the restrictive and malabsorptive parts of the procedure, for patients with varying weight loss needs. For example, super-obese BPD patients may be given a smaller stomach than usual, while for less obese BPD patients the surgeon may create a slightly longer length of “common channel” (the last 100-150 cm, 40-50 inches) to increase nutritional uptake and reduce the possibility of malnutrition. BPD bariatric procedures may be performed using traditional open surgery or the minimally invasive laparoscopic (keyhole) techniques.

What Is The Main Health Benefit Of BPD Bypass?

The main advantage of BPD obesity surgery is a high degree of weight loss in most patients. Biliopancreatic diversion patients typically lose 60-80 percent of their initial excess weight, compared to 50-70 percent weight loss for Roux-en-Y gastric bypass patients. In addition, the larger-than-usual stomach allows BPD patients to eat significantly more food than RYGBP patients.

What Is The Main Health Problem Associated With BPD Bypass?

The principal health danger of biliopancreatic diversion stomach bypass is malnutrition, which is a lifelong and constant health risk. The malabsorptive effect of the BPD operation is so severe that nutritional supplementation is mandatory for life. Vitamin B12 injection therapy, calcium and iron supplements or a daily multivitamin are also essential. Failure to maintain this regime of mineral and vitamin supplementation leads to a range of serious nutritional complications including anemia and osteoporosis.

Is BPD Bypass A Dangerous operation?

Yes. A Billiopancreatic Diversion bypass carries all the normal perioperative and post-operative health risks of any major surgical operation. There is a small risk of death, plus (very roughly) a 1 in 3 chance of significant post-op health complications. Specific side-effects from BPD include gastric staple breakage, a greater chance of chronic diarrhea, stomal ulcers, more foul smelling stools and flatus.

Who Can Qualify For Biliopancreatic Diversion Bypass Surgery?

To meet official bariatric regulatory standards and qualify for medical insurance cover, obese candidates must meet the following criteria:

Must Have High Body Mass Index
BPD candidates must have a BMI > 40, or BMI > 35 with added weight-related comorbidities such as heart disease, sleep apnea, severe mobility problems or a condition preventing employment.

History Of Weight Loss Failure
BPD Candidates must prove a history of failed attempts to lose weight using conventional weight loss diets and other body fat reduction programs, like Weight Watchers, Jenny Craig, or others.

Emotional Suitability For Obesity Surgery
Bariatric clinics routinely operate a vetting procedure for all candidates for BPD obesity surgery, to screen out patients who lack the necessary commitment to participate fully in the necessary post-op lifestyle of healthier eating and increased exercise.