Biliopancreatic Diversion

In this article, we will discuss Biliopancreatic Diversion (Overview). So, let’s get started.

Biliopancreatic diversion. Scopinaro developed the biliopancreatic diversion, creating malabsorption but avoiding the stasis associated with the intestinal bypass by maintaining a flow of bile and pancreatic juice through the biliopancreatic limb (Figure 1). The extent of malabsorption is thought to be a function of the length of the common channel, varying from 50-125 cm above the ileocecal valve. This procedure is combined with a subtotal gastrectomy as described by Scopinaro. A modification kpown as the biliopancreatic bypass with
duodenal switch (BPD/DS: Figure 2) consists of a sleeve gastrectomy in which the greater curvature of the stomach is resected creating a tubular section along the lesser curvature of the stomach.54 The pylorus is preserved, and an ileoduodenostomy is constructed distal to the pylorus. The alimentary and biliopancreatic limbs are generally of approximately equal length.

Figure 1. Biliopancreatic diversion. In this original description, an approximate 50%-80% gastrectomy is done. Limb lengths vary from a gastric bypass in that the enteroenterostomy is very distal, creating a common channel from 50-100 cm in length. The forward flow of bile
and pancreatic juice in the biliopancreatic limb is believed to reduce complications of bacterial statis that were associated with the long blind loop of intestinal bypass.
Figure 2. Biliopancreatic diversion with duodenal switch. In this procedure a gastric sleeve is created by vertical resection of the greater curvature of the stomach creating a long tubular stomach along the lesser curvature. A duodenoileostomy is done either end-to-end or end-to-side fashion, thereby preserving the pylorus. The intestinal lengths are similar to those described for biliopancreatic diversion.

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