Bilio Pancreatic Diversion (BPD)
- Greater stomach capacity (200-250 mls) therefore can eat a small main meal instead of an entrée portion.
- Best weight loss of all techniques 70-90% EWL over 2yrs
- Weight loss is well maintained
- Adjustable and partially reversible, but only by further surgery.
- A very good option for revision if other techniques have failed.
- Open operation ( usually), therefore greater operative risks e.g infection, Bowel leak, Clots to legs and lungs wound infection and hernia, chest infection. Risk of Death 1:200
- Malabsorbtion to some minerals vitamins and Protein . Patients must commit to taking lifelong supplements of the fat soluble vitamins ( A D E K ) Calcium and sometimes Iron.
- Risk of deficiency state e.g. Iron deficiency anaemia or osteoporosis if supplements not taken
- Take longer to recover ( 6-8 weeks off work)
- Requires removal of Gall bladder because of high incidence of stone formation
- Increased stool frequency 2-4/day
- Flatulance if fatty foods eaten
Sometimes it is offered to patients as part of a two stage Bypass operation particularly if they are super obese ( BMI>60) because it allows good weight loss until the patient gets down to a safe weight and the more radical bypass can then be offered laparoscopically when they are at a safer weight.
The residual stomach capacity is about 200mls so a generous entree should be possible.
The weight loss seems to be of the same order as a LAP-BAND® procedure ( 50-60% EWL) over two years but it is not adjustable.
It might also be a good option if patients have a problem with their Laparoscopic Band requiring revision, have already lost a lot of weight and don't want a full bypass.