Bilio-pancreatic diversion (BPD) is a restrictive and malabsorptive procedure.  Restriction is accomplished by surgically removing  the lower stomach and creating a pouch that is 8-9 ounces in size.  Malabsorption is accomplished through surgical bypass of a large portion of the small intestinal tract.  The common channel is 50-100 cm long.

Bilio-pancreatic Diversion (BPD)

Bilio-pancreatic Diversion (BPD)…An Italian invention

Bilio-pancreatic Diversion (BPD) weight loss surgery

The duodenal switch operation is derived from the Bilio-pancreatic diversion operation (B.P.D).   This weight loss operation was invented by an Italian Surgeon named Nicola Scopinaro.  This procedure is, for all intents and purposes, a long-limb RNY bypass.

Dr. Scopinaro combined a 65-percent gastrectomy with a long limb RNY. This procedure worked fairly well and was considered to be the most drastic of all weight loss surgeries.

Compare BPD to the RNY surgery

The limbs of the RNY Bypass:

Compare Bilio-pancreatic Diversion (BPD) to the Roux en Y (RNY) gastric bypass

 

A.  The limb of the RNY bypass that has food in it is called the “enteric” limb.

B.  The limb that contains the digestive juices(bile and pancreatic juice) is called the bilio-pancreatic limb.

C.  Where both limbs of the RNY meet—thus combining the digestive juices with the food—is called the “common” channel.

Other commonly used names

In the RNY bypass, the enteric channel is also known as the “efferent” limb (think of enteric and efferent—two e’s, or you can think of food exiting—another e, (or you can think of the popular cable channel, but then you would be thinking like the author and would need to have papers to prove sanity).  The limb of the RNY with the digestive juices is known as the “afferent” limb.

The Common Channel of the RNY and Biliopancreatic Diversion

If you consider that the common channel in the Scopinaro’s operation was reduced to 50-100 cm, you can see that this was a drastic step compared with most common channels.  In the proximal RNY limb, the common channel is 500 cm.  The difference accounts for why Scopinaro’s operation (known as the biliopancreatic diversion) was successful with weight loss.

Stomach restriction in the RNY and Biliopancreatic Diversion

All surgeries balance how weight loss is maintained. One component of “portion control” is also known as “restriction.”  Essentially, when the stomach is smaller, you cannot put in as many calories.  In Scopinaro’s operation, the stomach held 40 percent of its original capacity, larger than the one-ounce restriction of the standard Roux en Y gastric bypass.

Proximal
RNY
Distal
RNY
Duodenal
Switch
Scopinaro’s
BPD
Stomach size30 cc30 cc120-180 cc250 cc
Common channel500 cm100-400cm100 cm50-100 cm
Common
channel in inches
200 inches40 to 160 inches40 inches20-40 inches
Biliopancreatic limb length
in cm
(not including duodenum)
100 cm or less than 15% of the distance between the Ligament of Trietz and the colonFor some insurance purposes, anything longer than 100 cm bypassed is considered a distal bypass400 cm or about 60% of the distance between the ligament of Trietz and the colon400 cm or about 60% of the distance between the ligament of Trietz and the colon

Bariatric surgeons have yet to determine the best relationship between the restrictive component of weight loss and the moderate “malabsorptive” component.