What is biliopancreatic diversion?
The term “biliopancreatic diversion” refers to the fact that the digestive secretions of bile (bilis) and pancreas are not supplied to the food pulp until the lower part of the small intestine. As a result, the breakdown of nutrients is impeded and they are only absorbed from the small intestine into the blood in significantly smaller quantities.
What happens as a result of biliopancreatic diversion?
However, due to the biliopancreatic diversion, they are only introduced much further down into the small intestine. Only from here do the food pulp and digestive juices mix. This means that only a short section of the intestine and significantly less time is available for the breakdown and absorption of the food – a large proportion of the nutrients therefore migrates undigested into the large intestine and is excreted in the stool.
Surgical procedure for biliopancreatic diversion.
Preparation for biliopancreatic diversion.
Operation procedure
Biliopancreatic diversion proceeds in several surgical steps. Under general anesthesia, the surgeon inserts the instruments and a camera with a light source into the abdominal cavity through several skin incisions. During the operation, gaseous carbon dioxide is also introduced into the abdominal cavity so that the abdominal wall lifts slightly from the organs and the surgeon has better visibility and more space in the abdominal cavity.
Next, the surgeon cuts through the small intestine about 2.5 meters before the beginning of the large intestine. The lower part is now pulled up and sutured directly to the gastric pouch or the tubular stomach. The upper part of the small intestine no longer has a connection to the stomach and in the future will only serve to transport the digestive secretions of bile and pancreas. It is now routed into the small intestine about 50 centimeters above the colon and sutured.
Duration of surgery, hospital stay and incapacity for work.
Biliopancreatic diversion takes about two to three hours and is always performed under general anesthesia. The operation usually requires a hospital stay of about eight days – one for preparation and seven for close medical observation after the operation. On average, it is possible to resume professional activities about three weeks after the operation if the course is uncomplicated.
Biliopancreatic diversion is a procedure for people with obesity and a body mass index (BMI) of ≥ 40 kg/m² (obesity grade III). If metabolic diseases such as diabetes, high blood pressure or sleep apnea syndrome already exist due to the excess weight, biliopancreatic diversion may be useful from a BMI of 35 kg/m².
In people with extreme obesity (BMI > 50 kg/m²), the operation is sometimes also divided into two operations: First, only the tubular stomach is created. This is to reduce the weight and thus the surgical risk for the second operation (the actual biliopancreatic diversion).
For whom is biliopancreatic diversion not appropriate?
Efficacy of biliopancreatic diversion
Advantages of biliopancreatic diversion compared to other procedures
Disadvantages and side effects of the procedure
Biliopancreatic division is a surgically demanding procedure. Compared to tubular stomach surgery, it requires many more incisions and sutures. The interference with the digestive system is very pronounced and not completely reversible after successful weight loss. Therefore, one should be familiar with the possible side effects before the procedure. How severe these are in individual cases varies from person to person:
Therefore, regular vitamin B-12 administration into the muscle or into the blood via the vein is necessary throughout life. Vitamin B-12 preparations that are absorbed directly through the oral mucosa (sublingual application) are also available, but their efficacy is questionable.Why vitamin D deficiency may occur after biliopancreatic diversion has not yet been clarified with certainty.
Dumping syndrome: The term dumping syndrome is used to describe the combination of several symptoms that can result from the precipitous emptying of only slightly predigested food from the rest of the stomach into the small intestine. Since the stomach gate is missing, the concentrated food mush passes directly into the small intestine. There, following physical laws (osmosis), it draws water from the surrounding tissue and blood vessels into the intestine.
Dumping syndrome occurs mainly after the intake of osmotically very active (hyperosmolar) food, for example, sugary drinks or after fatty meals. The dumping syndrome is prevented by PBD-DS (see above). In this variant of biliopancreatic diversion, the gastric portal is preserved.
Biliopancreatic diversion: risks and complications
Biliopancreatic diversion carries several general and specific surgical risks. These include:
- general anesthesia risks
- Thrombosis of the deep veins of the legs with the risk of pulmonary embolism
- Infections in the area of the external and wound sutures
- Leakage of organ sutures at gastric pouch/tubular stomach or small intestine (suture insufficiency) with the risk of peritonitis
Diet after surgery
After biliopancreatic diversion, a basic change in diet is necessary to avoid digestive problems. Apart from that, the lower the fat and calorie diet after surgery, the more pronounced the weight loss will be. The following dietary rules must be followed for life after biliopancreatic diversion:
- Meals must include only small portions (reduced stomach size).
- Sugary foods or drinks and very long-fibered meats should be avoided
- Food supplements (especially vitamin D, vitamin B12) must be taken for life
Medications are also sometimes absorbed differently or in smaller amounts of active ingredients. Biliopancreatic diversion may therefore require adjustment of the timing and dose of medications.
