Is malnutrition seen with biliopancreatic diversion?
Yes. Protein has only 200 to 300 cm of ileum to be absorbed. Up to 30% of patients end up with protein-calorie malnutrition requiring hospitalization and TPN or surgical revision. A high-protein, lower-carbohydrate diet is required to avoid inducing a state of starvation mimicking kwashiorkor disease.
Are there other health risks associated with biliopancreatic diversion?
Yes. The risks are similar to gastric bypass except higher. Mortality is 1% to 2%. Leaks, obstructions, and ulcers can happen as well. Vitamin B 12 , folate, and iron deficiency anemia are common without lifelong supplementation. Hypocalcemia and bone demineralization are common, leading to bone pain and osteoporosis if calcium and vitamin D are not administered in high doses lifelong. Patients also complain of frequent diarrhea, foul-smelling stool and flatulence, and halitosis.
Why to choose biliopancreatic diversion?
Aside from being the most effective weight loss and metabolic improvement procedure, patients can eat as much as they want. This may be the best procedure for the binge-eater or compulsive snacker who classically fails the other weight loss procedures. The biliopancreatic diversion has also been proven to be effective for the so-called super morbid obese (BMI ≥ 50) who may not lose as much weight with the other procedures.