DRUGS ANG TREATMENT FOR FAT LOSS: BILIOPANCREATIC DIVERSION

Biliopancreatric diversion has a number of elements:

• Part of the stomach is removed leaving a pouch of between 200-400cc. This reduces the volume of food that can be eaten but not as drastically as with gastric partitioning.

• The small bowel is divided at a point 250cm from where it enters the large bowel. This lower part of the small bowel is attached to the stomach pouch so that food from the stomach has a shorter length of small bowel to digest it before it enters the colon.

• The upper 3-4 metres of small bowel is attached to the lower large bowel at a point 50cm from where it joins the colon. This part of the bowel carries the digestive juices from the liver and pancreas. Instead of having the usual 5-6 metres of small bowel to mix with and digest the food, the digestive juices can only act on the food for a distance of 50cm.

• The gallbladder, if present, is removed.

The effect of these measures is to produce restriction of food intake and to cause malabsorption of the food that is eaten, particularly of fats. Initially the effect is rapid weight reduction often accompanied by diarrhoea and feelings of weakness. However, by twelve months, the body adjusts allowing normal sized meals of any food types to be eaten and bowel actions to stabilise at about three bowel actions per day. Often adult onset diabetes and high cholesterol are cured by this procedure. There is no problem with acid reflux or vomiting. Weight control is well maintained even ten years after surgery. However, it is a major operation with risk of leaks, abscesses, adhesions, etc, in the short term, and of deficiencies of protein, iron, calcium and vitamins long term. Patients must remain under review and have six-monthly blood tests so that any developing deficiencies may be detected early and supplements prescribed to correct the problem before it becomes serious.

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