Thirty-five years of biliopancreatic diversion: notes on gastrointestinal physiology to complete the published information useful for a better understanding and clinical use of the operation.

BACKGROUND: In the attempt to complete the available information on biliopancreatic diversion (BPD) use and mechanisms of action, some data and observations are presented that for different reasons were never published before. METHODS: These pieces of information derive from minute efforts of gastrointestinal physiology research or from rigorous but preliminary and incomplete collection of data, combined with the daily input from clinical use of BPD. RESULT: They essentially regard intestinal limbs, gastric volume, and their interactions in affecting energy and protein intestinal absorption in BPD. CONCLUSION: It is hoped that this new information will help surgeons to increase their knowledge and improve their ability to obtain the best results from the BPD procedure.