Biliopancreatic diversion (BPD), originally described by Dr. Nicola Scopinaro in Italy in 1979, employs a predominantly malabsorptive technique.  It also has a modest restrictive component. 

General Procedure

The stomach is reduced to a 200-500 mL pouch, after removing the distal part of the stomach (hemigastrectomy). The small intestine is divided into an alimentary limb and a biliopancreatic limb. The proximal end of the alimentary limb is attached (anastomosed) to the remaining proximal stomach. The lower end of the biliopancreatic limb is then anastomosed to the terminal ileum within 50 to 100 cm distance from the ileocecal valve (the end of the small intestine, where the colon starts). Therefore, the intestinal tract is reconstructed to allow only a “common channel” of the distal 50-100 cm terminal ileum for absorption of fat and protein.

BPD can be done by making a large incision in the abdomen (an open procedure) or by making small incisions and using a small camera  (laparoscopic approach).

Today, a variation of the BPD procedure is performed called the biliopancreatic diversion with duodenal switch (BPD-DS). 

Advantages of Biliopancreatic Diversion:

• Produces the greatest amount of weight loss when compared to other weight loss surgeries (primarily due to the level of malabsorption achieved).
• Ability to consume larger meals than with other surgeries that are restrictive in nature.
• Long term weight loss can be successful if patient follows strict guidelines pertaining to diet, nutritional supplementation, exercise, and lifestyle.

Disadvantages/Risks of Biliopancreatic Diversion:

• Increased chance of side effects and long-term problems than with traditional gastric bypass surgeries such as Roux-en-Y.
• Excessive bloating can occur when high fat content foods are consumed.  This can be accompanied by foul smelling flatulence and bowel movements.
• Bowel movements can be frequent with a watery consistency while the intestinal tract is adapting to the change.  This condition can fade over time but for some patients remains permanent.
• Reflux and ulcers can occur as a result of the bile, pancreatic and digestive juices being re-routed.  The BPD-DS (Duodenal Switch) modification of this operation has decreased the frequency of this side effect.