Laparoscopic malabsorption procedures: Management of nutritional complications after biliopancreatic diversion

Abstract

Contemporary laparoscopic malabsorptive bariatric procedures are mostly of the biliopancreatic diversion type, either the Scopinaro procedure with a distal gastrectomy and a gastroileal anastomosis or the duodenal switch procedure with a sleeve gastrectomy and a duodenoileostomy. Aside from surgical complications, nutritional complications related to these procedures are particular and mandate careful attention and follow-up in the perioperative period to address preexisting nutritional derangements and maintain the benefits in the long term after surgery. Because the number of bariatric procedures involving gastrointestinal reconfiguration has increased dramatically, it is important for clinicians involved in the care of bariatric patients to be familiar with a variety of nutritional conditions associated with BPD surgery over time to allow for prompt recognition and management of potentially serious postoperative complications, including a few nutritional emergencies. This chapter reviews important early and late nutritional complications specific to laparoscopic biliopancreatic diversion with or without duodenal switch.