Laparoscopic Adjustable Gastric Banding :: Biliopancreatic Diversion BPD

Tube Gastrectomy :: Gastric Bypass

Biliopancreatic 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 but if fatty foods are overeaten e.g. a hamburger and fries then diarrhoea and foul flatus will result.

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

Disadvantages:

• 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 ( 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 lap band requiring revision, have already lost a lot of weight and don't want a full bypass.