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Biliopancreatic diversion
A biliopancreatic diversion is a surgery considered for severely overweight individuals to help them lose weight.
What is biliopancreatic diversion?
Biliopancreatic diversion (BPD) is a type of weight-loss (bariatric) surgery that involves making your stomach smaller and bypassing the upper part of your small intestine. Food travels directly to the lower part of your small intestine where it mixes with digestive juices, meaning you absorb fewer calories and nutrients and resulting in rapid weight loss.
Biliopancreatic diversion is considered one of the most radical weight loss surgeries and is normally only recommended for people with severe obesity (a body mass index (BMI) of 50 or above) where other weight loss methods have been unsuccessful.
This page explains what biliopancreatic diversion is, what happens during the surgery and what to expect during your recovery.
How much does biliopancreatic diversion cost?
The cost of biliopancreatic diversion treatment depends on your individual circumstances. At the time of your appointment your consultant will discuss all options with you and ensure all your questions are answered.
Our fixed-price packages include the cost of your surgery and all appropriate aftercare appointments. However, any pre-surgery diagnostic tests and your consultant's outpatient appointment consultation fee are charged separately.
Our flexible payment options help you spread the cost of your payment across a time period that suits you.
Why might I need a biliopancreatic diversion?
Your consultant may recommend biliopancreatic diversion if you have a body mass index (BMI) of over 50 and have tried to lose weight through other means such as diet and exercise without
success. Being overweight or obese increases your risk of serious and often life-threatening health conditions such as high blood pressure, heart disease, and type 2 diabetes.
What are the benefits of biliopancreatic diversion?
The main benefit of biliopancreatic diversion is rapid and significant weight loss. Many patients who have undergone biliopancreatic diversion surgery lose between 75 and 80% of their excess body weight after five years. In many cases, this type of bariatric surgery is more effective in keeping the weight off than other weight loss surgeries. Weight loss following biliopancreatic diversion reduces your risk of many serious health problems and can resolve conditions associated with obesity such as obstructive sleep apnoea and type 2 diabetes as well as improve your overall quality of life.
Are there any alternatives?
Biliopancreatic diversion is normally only recommended when other weight loss methods have failed. Your consultant will weigh up the risks of having the procedure against the health risks associated with obesity. In some cases, your consultant may recommend an alternative bariatric procedure with a lower risk of complications. The type of bariatric surgery your consultant recommends depends on several factors including your weight, general health, and how much weight you aim to lose.
Some alternatives to biliopancreatic diversion include:
- Gastric bypass
- Gastric sleeve (sleeve gastrectomy)
- Gastric band
- Gastric balloon
What to expect at your initial consultation
At your first consultation, you will be seen by a consultant bariatric surgeon, a doctor specialising in weight loss procedures such as biliopancreatic diversion.
Your consultant will ask you about your general health, medical history, and any medications you take regularly. They will ask you about your previous attempts to lose weight and how successful they were.
Before deciding whether biliopancreatic diversion is an appropriate procedure for you, your consultant will conduct a thorough assessment including your physical, emotional and mental health, nutritional status and expectations for treatment.
Having biliopancreatic diversion surgery is a major decision that requires a long-term commitment from you and involves making changes to your diet and lifestyle and having regular medical check-ups for the rest of your life. Make sure you fully understand what is involved in having biliopancreatic diversion surgery, including the benefits, risks, possible complications and what is involved in your recovery.
Your first appointment is important as it’s where you’ll meet your consultant, the doctor responsible for your care. Your consultant will take time to get to know you, discuss your expectations for treatment and encourage you to ask any questions you may have. At Circle Health Group, we want you to be as well-informed and comfortable as possible during your time with us, so please discuss any questions or concerns with your consultant during your appointment.
At the end of your appointment, your consultant will decide if biliopancreatic diversion is a suitable procedure for you based on your BMI, previous weight loss attempts, general health and expectations for treatment. They will explain the procedure to you in full, including how to prepare for your surgery, any potential risks and complications and what to expect during your recovery.
How to prepare for biliopancreatic diversion
Your consultant will tell you everything you need to do to prepare for your biliopancreatic diversion. Instructions on how to prepare will also be in your appointment letter.
If there’s anything you’re not sure about, or if you have any questions, please contact the hospital for advice.
Pre-operative assessment
Around a week or two before your surgery, you will need to attend the hospital for a pre-operative assessment to make sure you are fit for surgery. Take any medication you take regularly with you to your appointment. At the preoperative assessment, we will check your weight and blood pressure and order tests such as a blood test, chest X-ray and electrocardiogram (ECG) to evaluate your general health.
Optimise your general health
It's important to be in the best possible health before your biliopancreatic diversion. This will allow your procedure to go as smoothly as possible, speed up your recovery and reduce the risk of any complications after your surgery.
To ensure you are as healthy as possible before your surgery:
- Stop smoking at least eight weeks before your procedure. Smoking increases the risk of complications such as breathing difficulties and infection and can impair wound healing. Your consultant can offer you advice and support with quitting smoking before your surgery.
- Follow a healthy, nutritious diet
- Take regular exercise
- Avoid alcohol for a few days before and after your surgery. Alcohol thins your blood and can increase the risk of bleeding during your operation.
Preparing your home
You will need some help with day-to-day tasks such as shopping, cooking, driving and housework for a week or so after your biliopancreatic diversion. Please make arrangements for this before your operation. You can also facilitate your recovery by preparing your home in advance. This may include:
- Stocking up on food and preparing meals in advance that you can freeze and heat up during your recovery
- Removing things you can trip over like low tables, magazine stands and rugs
- Keep things you use regularly such as your glasses, medications, useful telephone numbers, a book and the TV remote control within easy reach
Regular medications
Your consultant may tell you to stop taking certain medications, such as blood thinners for a few days before your surgery. This is to minimise the risk of bleeding during and after your procedure.
On the day of your surgery
On the day of your surgery, take a shower before you arrive at the hospital. Do not apply any products to your skin such as lotions, creams, makeup or perfume. Leave any valuables and jewellery at home. You will not be able to eat or drink anything from midnight on the day of your biliopancreatic diversion surgery.
What happens during biliopancreatic diversion?
Before your surgery, you’ll need to sign a consent form to say that you agree to have the procedure and are aware of what it entails and the possible risks and complications of the surgery.
Biliopancreatic diversion is performed under general anaesthetic, meaning you’ll be asleep for the procedure and won’t feel any pain.
Biliopancreatic diversion can be performed as either laparoscopic (keyhole) surgery through small incisions or as open surgery. Most surgeons prefer open surgery as this gives them a better view of your organs than can be achieved with laparoscopic surgery.
Once the anaesthetic has taken effect, your consultant will make an incision (cut) along the front of your abdomen.
Your consultant uses staples to divide your stomach and create a narrow tube (gastric sleeve) that is about a quarter of the size of your original stomach. The rest of your stomach is removed.
Your consultant will then bypass a large part of your small intestine, making it shorter and attaching one end to your gastric sleeve and the other to the final portion of your small intestine.
Once the surgery is complete, your consultant will close the incision with stitches and apply a sterile dressing.
Biliopancreatic diversion with duodenal switch (BPD/DS)
This is a variation of biliopancreatic diversion that involves removing a different part of the stomach and leaving the valve between the stomach and intestine (the pylorus valve) intact. BPD/DS is normally only performed if you have a BMI over 50 and a serious health condition.
Recovering from biliopancreatic diversion
Recovering from any type of surgery is a gradual process that is different for everyone. How soon you recover from your biliopancreatic diversion surgery depends on several factors including your age, general health, the type of procedure you had and your individual recovery process. You can help your recovery go more smoothly by being as well-informed as possible about your surgery and recovery and following your consultant’s post-operative instructions carefully. Call the hospital if you have any questions or concerns.
After your biliopancreatic diversion, you will be taken to the recovery room where you will be monitored closely until the anaesthetic has worn off. You will then be taken to your room.
After your biliopancreatic diversion surgery:
- You may feel some pain or discomfort in your abdomen after your surgery. The nursing staff will give you medication to manage this.
- Your consultant will give you instructions on how to care for your surgical wound, when you can take a shower and when you need to return to the hospital to have your stitches removed
- You’ll be given clear instructions on what you can eat after your biliopancreatic diversion surgery. You’ll start on a liquid diet, (normally for around two weeks), moving to pureed food, soft food and gradually returning to firmer foods as your body tolerates them.
- You’ll need to take vitamin and mineral supplements for the rest of your life after your biliopancreatic diversion. This is because you won’t be able to absorb enough essential nutrients after your operation.
- Light activities such as walking every day are beneficial during your recovery, but avoid strenuous activity and heavy lifting until your consultant tells you it’s ok
- Our team of expert dieticians will work with you to create a healthy, nutritious eating plan after your biliopancreatic diversion surgery
How many nights will I need to stay in hospital?
How long you need to stay in hospital after your biliopancreatic diversion depends on the type of surgery you had and your individual recovery. You can expect to spend one to two nights in hospital after laparoscopic (keyhole) surgery and several days after open surgery.
Will I be able to drive home?
You will not be able to drive yourself home from hospital after your biliopancreatic diversion. Please arrange for someone to collect you, or we can organise a taxi if you prefer.
How soon can I go back to work?
When you can go back to work after your surgery depends on how soon you recover and the type of job you do. You can expect to take between two and six weeks off work after your biliopancreatic diversion.
When can I drive?
You can drive when you can safely control your vehicle, wear a seatbelt comfortably and perform an emergency stop without any abdominal pain. This is usually around six weeks after your surgery.
Do not drive while taking strong painkillers or any other medication that can affect your concentration and impair your reaction times.
When will I be back to normal?
Though it varies from person to person, you can expect to resume most normal day-to-day activities around four to six weeks after biliopancreatic diversion surgery.
Potential risks and complications of biliopancreatic diversion
Biliopancreatic diversion is a major operation and as with any type of surgery, there is a risk of side effects and complications, some of which can be serious or life-threatening.
Your consultant will explain all the possible risks and complications of biliopancreatic diversion before your procedure and answer any questions you may have. It’s important that you are fully informed about any possible risks and complications before your procedure and can make an informed decision. You can help minimise the risk of complications by following the instructions you are given on how to prepare for your procedure and what to do afterwards.
For the first three to six months after your biliopancreatic diversion, you may experience the following symptoms as your body adjusts to the rapid weight loss.
- Flu-like symptoms such as fatigue and body aches
- Dry skin
- Feeling cold
- Hair loss and/or thinning hair
- Mood changes
Possible complications of any type of surgery may include:
- Adverse reactions to the anaesthetic
- Bleeding
- Blood clots in the legs or lungs
- Wound infection
- Damage to nearby structures
- Chest infection
In addition to the above, possible complications of biliopancreatic diversion may include:
- Peritonitis: Deep abdominal infection which may lead to sepsis (blood poisoning)
- Gastrointestinal perforation: Leakage of the stomach contents into the abdominal cavity
- Nutritional deficiencies: Vitamin and mineral deficiencies such as anaemia and deficiencies in iron, fat-soluble vitamins, vitamin D and vitamin B12 are common after bariatric surgery. You will be advised to take daily supplements and have regular checkups to monitor your vitamin and mineral levels.
- Dumping syndrome: Occurs when undigested food moves too quickly from the stomach to the small intestine causing symptoms such as bloating, sweating, abdominal pain and nausea
- Bowel obstruction: A blockage in the bowel that can occur months or years after surgery
- Gallstones: Are a common side effect of rapid weight loss
- Hernia
- Vomiting: This is common in the first few days after surgery and is often caused by eating too quickly
- Diarrhoea: Can be caused by malabsorption and food intolerances
- Osteoporosis
Why choose Circle Health Group for biliopancreatic diversion?
At Circle Health Group, we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care including:
- Flexible appointment times and locations that are convenient for you
- The freedom to choose which hospital and consultant suit your needs
- Personalised, consultant-led treatment plans tailored to your individual needs
- Comfortable and safe private facilities maintained by expert multidisciplinary teams
- Private ensuite rooms as standard
- A range of delicious healthy meals
- Affordable, fixed-price packages with aftercare included
- Flexible payment options to help you spread the cost of your care
If you would like to see a consultant or learn more about biliopancreatic diversion, book your appointment online today or call a member of our team directly on 0808 189 5499.
Clinical review and sources
- Biliopancreatic diversion (BPD) Medline Plus
- BPD/DS Weight-Loss Surgery Johns Hopkins Medicine
- Biliopancreatic Diversion Penn Medicine
- Biliopancreatic Diversion With Duodenal Switch National Library of Medicine
