Laparoscopic Biliopancreatic Diversion Scopinaro (LBPD Scopinaro)
General Information
The Biliopancreatic Diversion according to Scopinaro is a surgical procedure that can be performed by miniinvasive (Video)surgery. The procedure mildly influences food intake AND very strongly reduces the absorption of nutrients from the intestinal tract. Absorption of nutrients is limited because a large part of the intestines is bypassed and not used. The food is processed so quickly that there is less time to absorb the nutrients. The volume of the stomach after BPD is between 250 and 500 ml, the active intestinal tract – common channel (where the food and digestive fluids come together) is only 50 cm long.
The alimentary limb (AL, green in the image) after BPD is 200cm long, the biliopancreatic limb (BPL, pink in the image) consists of the rest of the small intestine.
Indications for BPD-DS
- BMI over 50
-
Treatment of:
- Diabetes Mellitus type II
- arterial hypertension
- hyperlipoproteinemia
- other related diseases
- Redo surgery after other metabolic operations in patients with high compliance
- accepts obligatory supplementation of vitamins and minerals
- sweet eaters
- binge (volume) eaters
- stress eaters
- patients with heartburn
Advantages
- very successful (70-90% of excess weight loss)
- Operation for patients in whom restrictive procedures like balloon, banding and sleeve gastrectomies failed
- Operation for volume eaters
- Operation for stress eaters
- Operation for patients with heartburn
Disadvantages
- relatively high early complication rate (like dumping syndrome)
- mortality 1 – 2% rate, increasing with BMI
- irreversible change in the anatomy
- Life-time vitamins and minerals after surgery
- Foul-smelling flatus
- Flatulence
- Diarrhoea
- Malabsoption (Short Intestine Syndrome)
Operation Time
- The BPD procedure takes between 2.5 and 3 hours.
Technical description
Laparoscopic Biliopancreatic Diversion by Scopinaro reduces the size of the stomach through surgical horizontal stapling. This type of weight loss surgery cuts the stomach and leaves a reservoir of approximately 250 – 500ml in size. Then, two distances are measured: the last 50cm and 250 cm of distal small intestine. The intestine is separated with a stapler machine (GIA) (which suturies and cuts at the same time). Then follows the intestinal junction (called Jejuno-Ileo anastomosis JIA) perfomed with GIA and hand suture between the end BPlimb and the alimentary limb. Afterwards the junction is created between the stomach and the alimentary limb. The connection directs the food immediately from the stomach to the last 1/3 of the intestines. The first 2/3 of the intestines are now bypassed and are not used anymore for food absorption.
Hospitalisation Time
- The procedure requires a 4-to-7-night stay in the hospital after the operation.
After Surgery After surgery
the patient must follow special diets and vitamin intake to lose weight in a controlled manner.
Lab Tests:
- Morphology1
- Electrolytes1
- Ferrum1
- Creatinin
- Liver ferments1
- Vitamins B1, B12-level1
- HDL, LDL, VLDL, Chol2.
- Ferritin2,3
- Transferrin2,3
- Zink2,3
- Magnesium2
- 1,25-Dihydroxy-Vitamin D3, Vitamin A2,3
- Haemoglobin A1c2
- Parathormon2,3
- Parathormon - Related Protein2
1. 1 Mo, 3 Mo, 6 Mo, yearly
2. 6 Mo, 1 year
3. yearly
Supplementation
|
2000mg (with 130ug) per Day |
|
1 tab. per Day |
|
1 tab per Day 30mg – one week long in a month, (3 weeks without the Ferrum) Ladies best start after Menstruation |
|
70-90g per Day |
|
every 3 Months i.m. (1000ug) or 25000 I.U. sublingual 2 time a week |
|
1 tab. 1mg per Day |
|
1 tab. 2.5mg per Day |
|
1 tab.15 mg per Day |
|
Daily for 4 Months |
Bariatric Analysis and Reporting Outcome Score – BAROS
- Once a year
Standard Medication after Operation
- PPI 20mg, 0-0-1 (3 Months)
Sport and physical activity
- Three weeks after operation
- 3 hours of physical activity per week but under sport medical supervision and medical advice.
