Biliopancreatic Diversion

 

Biliopancreatic diversion is a fundamentally malabsorptive technique or group of techniques indicated in patients with a higher degree of obesity or metabolic disorders that are difficult to control.

 

In this kind of procedures, the normal process of digestion is modified by reducing the size of the stomach and bypassing the food to bypass part of the small intestine so that fewer calories are absorbed from the food eaten.

Due to the complexity of this procedure and the possible side effects of malabsorption (abundant and loose stools, flatulence, hypovitaminosis, among others) this surgery is reserved for patients who are extremely obese and who have not been able to lose weight in any other way. Extreme or grade IV obesity means having a BMI (body mass index) of 50 or higher.

 

The classic biliopancreatic diversion or Scopinaro technique was the first described of this type. Subsequently, several modifications were made to the original technique and other variants were added that are carried out today with very good results, such as:

 

• The classic biliopancreatic diversion or Scopinaro technique, is performed by removing part of the stomach. The rest of the stomach connects to the lower portion of the small intestine (Roux-en-Y), diverting the food eaten so that the amount of nutrients absorbed is limited.

 

• The duodenal switch is carried out by removing a different portion of the stomach performing a tubular or vertical gastrectomy with preservation of the pylorus (valve that controls the exit of food from the stomach) to later avoid most of the intestine by connecting the final portion of the intestine thin with the duodenum close to the stomach.

 

• The SADI-S, named for its acronym in English (Single duodenal-ileal bypass with sleeve gastrectomy), that is, a duodenal-ileal bypass, with tubular or vertical gastrectomy, is actually a modified and simplified duodenal switch surgery . In this technique, only one anastomosis is needed, that is, a single connection, which reduces the time of surgery and the complexity of the intervention.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The change in size of the stomach and the redirection of the intestine are designed to cause the patient to consume smaller amounts of food and not fully absorb all that is ingested.

Because the food will come into contact with a smaller portion of the intestine, a good part of the nutritional and caloric elements of the food will not be processed or absorbed. Biliopancreatic diversion allows extremely obese patients to lose weight faster and maintain it over time.

 

What people could benefit from a Biliopancreatic Diversion?

 

• Women and men with obesity associated with other diseases that are difficult to control ( diabetes, hypertension, high cholesterol, sleep apnea, osteoarthritis, among others).

• People with extreme obesity or a BMI greater than 50.

• Obese patients in whom other bariatric techniques are contraindicated.

• Obese women and men in whom other bariatric surgical procedures have failed.

 

What are the advantages of Biliopancreatic Diversion?

 

• This procedure is performed with minimal incisions leaving very small scars.

• The surgery is performed with a minimally invasive technique that allows a reduction in hospitalization time and faster recovery.

• In the case of the duodenal switch and SADI-S, the possibility of alkaline reflux is reduced in a large percentage of patients since by preserving the pylorus, the bile cannot rise to the stomach or esophagus and injure it.

• The results of more than 70% of the excess weight lost in the first year after surgery support this technique.

• During the procedure, no devices or prostheses (such as the band or the balloon) are placed that later have to be monitored or removed.

• Better control or remission of metabolic diseases such as diabetes, hypertension, high cholesterol, osteoarthritis, sleep apnea in patients with extreme obesity.