The main feature that distinguishes the BPD operation is limiting absorption of calories, especially fat by limiting the length of bowel used in digestion of food. In a sense it is more of a radical bypass. On the other hand the stomach is kept a bit on the large side allowing patients to eat larger quantities to avoid protein malnourishment. There are at least two variations to the BPD including the Scopinaro operation and the duodenal switch.
The long-term results of the BPD are the best in terms of weight loss and resolution of obesity related co-morbidities. The average %EWL is around 70-80% even after 10 and 15 years.
Because of the severe shortening of bowel length side effects related to poor intestinal absorption are quite common. These include diarrhea, foul smelling stools, foul smelling gas, vitamin deficiency, osteopenia, poor vision, protein loss etc.. Follow-up of nutritional and vitamin deficiencies is very important.
The Scopinaro operation is easier to perform than the duodenal switch and the risk of complications related to the operation is similar if not less than the RYGB. The duodenal switch on the other hand is more difficult to perform and is associated with the highest risk of manor complications and mortality among all bariatric operations.
The BPD operations take 2-4 hours to complete laparoscopically. The average length of stay in the hospital is 2 days. The transition of diet from liquids to solids takes about two weeks. Most patients return to work within 10 days and to exercise within three weeks of the operation.
As mentioned earlier, long-term nutritional deficiencies are common so it is important to stay on vitamins lifelong and follow-up periodically with blood tests and visits to the doctor.
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