Bilo pancreatic diversion (BPD)

This is malabsorptive operation that can be done as either an open operation through a midline incision from the base of the breastbone, or laparoscopically.

Most of the stomach (about 75%) is removed and the small pouch that remains is connected directly to the final segment of the small intestine, totally bypassing the duodenum and jejunum (first and second sections of the small intestine). Bile and pancreatic juices are also diverted to enter the intestine lower down, closer to the middle or end of the small intestine. Most of the fat and carbohydrate eaten passes through the body without being absorbed.

Diagram of bilo pancreatic diversion (BPD)

This has the effect that the patient is less restricted in their eating than after a RNY gastric bypass because fats and sugars are not absorbed by the intestine. However, although weight loss after this operation is good, like DS patients, many find the foul smelling flatulence and loose stools they experience, most unpleasant.  This operation also carries a risk of the development of ulcers or strictures at the junction of the stomach and the small intestine.

Some patients who would have in the past been offered a BPD may now be offered the duodenal switch  operation instead, and both of these operations are best in the hands of very experienced surgeons.