BILIOPANCREATIC DIVERSION

Biliopancreatic diversion (BPD) has made reacceptable the malabsorptiv e approach to the surgical treatment of obesity. The procedure, in a s eries of 2241 patients operated on during a 21-year period, caused a m ean permanent reduction of about 75% of the initial excess weight. The indefinite weight maintenance appears to be due to the existence of a threshold absorption capacity for fat and starch, and thus energy, an d the weight loss is partly clue to increased resting energy expenditu re. Beneficial effects other than those consequent to weight loss or r educed nutrient absorption included permanent normalization of serum g lucose and cholesterol without any medication and on totally free diet in 100% of cases, both phenomena being due to a specific action of th e operation. Operative mortality was less than 0.5%. Specific late com plications included anemia, less than 5% with adequate iron or folate supplementation (or both); stomal ulcer, reduced to 3.2% by oral H-2- blocker prophylaxis; bone demineralization, increasing up to the fourt h year and tending to decrease thereafter, with need of calcium and vi tamin D supplementation; neorologic complications, totally avoidable b y prompt vitamin IE administration to patients at risk; protein malnut rition, which mas reduced to a minimum of 3% with 1.3% recurrence, in exchange with a smaller weight loss, by adapting the volume of the gas tric remnant and the length of the alimentary limb to the patient's in dividual characteristics. It is concluded that the correct use of BPD, based on the knowledge of its mechanisms of action, can make the proc edure an effective, safe one in all hands.