Revisional Surgery After Bilio-Pancreatic Diversion: Indications, Outcomes, and Complications in a High-Volume Center.

BACKGROUND

Bilio-pancreatic diversion (BPD), once a prominent bariatric procedure, has seen a marked decline in use due to high rates of nutritional deficiencies and frequent need for surgical revisions. Despite this, BPD remains in practice in select centers, leading to a persistent cohort of patients requiring revisional surgery.

METHODS

We conducted a retrospective review at a high-volume bariatric surgery center to identify all patients who underwent revisional surgery following primary BPD between January 2015 and December 2025. Inclusion criteria were age ≥ 18 years, documented primary BPD, and complete clinical data. Demographics, surgical details, indications for revision, types of revision, and outcomes were analyzed.

RESULTS

Forty-six patients underwent revision after Scopinaro BPD. Malnutrition/malabsorption (47.8%) and weight regain (37.0%) were the leading indications. Common tract lengthening and gastric pouch resizing were the most frequent revision types. Post-revision, mean weight and BMI decreased further, and gastrointestinal symptoms improved significantly: diarrhea (80.0% to 4.4%), flatulence (90.9% to 20.5%), and abdominal pain (45.5% to 0%). Post-revision surgical complications occurred in 19.6% of patients, most commonly intestinal occlusion (6.5%), with other serious events including volvulus, anastomotic dehiscence, splenic necrosis with pancreatic fistula, perianastomotic hematoma, jejuno-jejunal leak requiring open abdomen, and evisceration with dehiscence (each 2.2%). Most complications required laparotomy, and one patient (2.2%) died due to a jejuno-jejunal leak.

CONCLUSIONS

Both malnutrition and weight regain are leading causes for revision after BPD. Revisional surgery is technically demanding but can be performed laparoscopically. However, it should be reserved for experienced centers, as complications following revision are often serious, frequently requiring laparotomy and, in some cases, may require a second intervention or result in mortality. These findings underscore the need for careful patient selection and long-term follow-up after BPD.