Biliopancreatic Diversion | Pristyn Care

Risk Factors

Risk factors for requiring BPD-DS include:

• Super-obesity (BMI above 50)
• Multiple failed bariatric procedures
• Severe uncontrolled metabolic syndrome
• Pre-existing nutritional deficiencies
• Advanced liver disease (NASH/cirrhosis)
• Significant cardiovascular comorbidity

Who Is a Candidate

Super-obese patients with BMI above 50, patients with severe type 2 diabetes and metabolic syndrome, and those who have failed previous bariatric procedures are primary candidates for BPD-DS. Pre-operative optimisation is essential.

Diagnosis

Pre-operative evaluation includes:

• Comprehensive metabolic blood panel with nutritional markers
• Liver biopsy or fibroscan for NASH assessment if indicated
• Upper GI endoscopy and swallow study
• Cardiac stress testing and pulmonary function tests
• Sleep study for obstructive sleep apnoea
• Multidisciplinary bariatric team assessment over multiple visits

Treatment: Biliopancreatic Diversion

Pristyn Care performs laparoscopic BPD-DS with a standardised sleeve gastrectomy followed by duodenal switch, achieving over 80% excess weight loss with near-universal diabetes remission in eligible patients.

BPD-DS Surgical Procedure

Procedure involves:

• Sleeve gastrectomy along the lesser curvature
• Division of the duodenum just beyond the pylorus
• Measurement of small bowel: alimentary limb 150-250 cm from ileocaecal valve
• Common channel of 75-100 cm for combined food and digestive juice mixing
• Duodeno-ileostomy anastomosis and ileo-ileostomy
• Leak testing and drain placement
• Total operative time 3-5 hours under general anaesthesia

After the Surgery

Post-operative care includes:

• Strict lifelong supplementation: fat-soluble vitamins (A, D, E, K), calcium citrate, iron, B12, zinc
• High-protein diet (minimum 60-80g protein per day)
• 4-6 hourly small meals to maximise absorption
• Quarterly blood tests for nutritional monitoring
• Annual DEXA scan for bone density
• Lifelong follow-up with bariatric dietitian and surgeon

Possible Complications of BPD-DS

Potential complications include:

• Protein-calorie malnutrition (most significant long-term risk)
• Fat-soluble vitamin deficiencies (A, D, E, K)
• Severe diarrhoea and malodorous stools
• Anaemia from iron and B12 deficiency
• Metabolic bone disease from calcium and vitamin D deficiency
• Anastomotic leak (higher risk than simpler bariatric procedures)
• Night blindness from vitamin A deficiency