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Biliopancreatic diversion according to Scoinaro "Ad hoc stomach", biliopancreatic diversion (Fig. 2)

This method is an advanced development of the intestinal bypass and was introduced in 1976 by Nicola Scopinaro (Genoa), who treated an impressive number of patients (approx. 2000) over a long period. It is a demanding therapy which is potentially dangerous due to post-operative and long-term complications; in terms of weight-loss, however, it is extremely effective. In principle two mechanisms are combined:

  1. For temporary initial weight-loss a distal gastrectomy is performed, meaning partial removal of the lower part of the stomach leaving a remaining stomach of a defined volume of 200-500ml. Intestinal continuity is reconstructed by connecting the remaining stomach with approx. 200cm distal (lower) small bowel, which allows for a quick shunt into the lower small bowel (Ileum).
  2. The body weight is maintained by a biliopancreatic diversion (diversion of digestive juices) via a permanent and selective malabsorption (reduced absorption) of fats and starches. The disabled proximal (upper) small bowel part containing all digestive enzymes of the pancreas and the liver bile is connected to the lower small bowel about 50cm above the crossover to the colon. Thus the fat- and starch-absorbing small bowel surface, which requires digestive juice from the pancreas and liver bile, is reduced to an extent where only small amounts are "digested" and absorbed into the body. Protein absorption in the bowel on the other hand is hardly reduced at all, and monosaccharides are absorbed in an unconstrained manner. Furthermore, the gallbladder is removed to counter gallbladder ailments which often occur along with rapid weight-loss.
    3. Intestinal bypass
    Fig. 2: "Ad hoc stomach"(AHS),
    biliopancreatic diversion (BPD)

    Compared to the intestinal bypass, complications are less common with this procedure. Lethality is between 0.8% (post-operative years) and 0.4% (Scopinario), provided the procedure is performed in an experienced medical centre and the after-care plan is strictly adhered to. The procedure includes extensive modifications to the normal anatomy of the gastro-intestinal tract and requires lifetime patient monitoring for deficiencies such as mineral (iron, calcium), vitamin (mainly liposolubles and vitamin B complex) and protein deficiencies, which immediately need to be countered by supplementation. Because of its efficiency in terms of weight loss, this method has gained popularity over the last view years, and except for Italy and some other European countries is also performed in the USA.