TREATMENT OPTIONS

Obesity Surgery

Laparoscopic Adjustable Gastric Banding :: Biliopancreatic Diversion BPD
Sleeve Gastrectomy

Bilio Pancreatic Diversion BPD

These operations combines removal or exclusion of 2/3rds of  the stomach along with a long intestinal bypass which significantly reduces the absorption of fat. The capacity to eat is greater than with the other operations, and the eventual weight loss is the best of all the operations If fatty foods are eaten then diarrhoea and foul flatus will result.

“Scopinaro” type Bilio-Pancreatic Diversion

Advantages:

• 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.
• Almost certain resolution of type 2 diabetes

Disadvantages:

• Open operation
• Greater operative risks e.g infection, bowel leak, clots to legs and lungs, wound infection and hernia, chest infection.
• Risk of Death 1-2% (1-2:100)
• Malabsorbtion of 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 and Zinc.
• Risk of deficiency state e.g. Iron deficiency anaemia or osteoporosis if supplements not taken
• Take longer to recover ( 6-8 weeks off work)
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• Increased stool frequency 2-4/day 
• Flatulance if fatty foods eaten

I generally prefer the Duodenal Switch type Bilio-Pancreatic Diversion procedure, if you have not had previous weight loss surgery before, or if you have had an adjustable gastric band that has not been satisfactory for you. However, if you have had previous gastric stapling, I generally prefer conversion to the Scopinaro type procedure (see above). In my experience the two operations produce very similar results in the long term.