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Bosnian advances

First BPD performed in Bosnia and Herzegovina

Miroslav Bekavac-Beslin presented the case at Alpine Experts 2012
Successful operation on 25-year-old man with BMI of 77
Complication-free procedure led to resolution of T2DM symptoms

The first biliopancreatic diversion (BPD) performed in Bosnia and Herzegovina shows that surgeons in former Yugoslav states are beginning to catch up with the latest bariatric technologies and techniques, following development of the science being impeded by years of civil war.

The surgery, performed by a multidisciplinary team at the University Clinic Centre in Tuzla and presented by Professor Miroslav Bekavac-Beslin at the Expert Meeting for the Surgery of Obesity in Austria, also marks the first malabsorptive procedure carried out in the country.

The operation was performed as part of a project to develop the bariatric surgery unit in UCC Tuzla, with the intention for it to become a referential centre for bariatric surgery in Bosnia and Herzegovina. The case study was published in the Official Journal of the Association of Surgeons of the Federation of Bosnia and Herzegovina


The patient chosen for the operation was a 25-year-old man with a BMI of 77, with comorbidities including metabolic syndrome, observable deterioration of knee joints, and episodes of sleep apnea. As the team had a large amount of experience in abdominal surgery, two experienced anesthesiologists, and nursing care, nutritionists, and the logistics in place, they decided to perform an open biliopancreatic diversion.

The surgery lasted 3.5 hours. Hemigastrectomy was performed with linear staplers, two anastomoses on the stomach and intestine were performed using the one-line manual technique, and the gastrointestainal anastomosis was tested on the operational table with methylene blue.

In the early post-operative period, said Bekavac-Beslin, the patient was breathing spontaneously. In the intensive care unit immediate and continuous analgesic was administered, with breathing exercises under supervision of respiratory physical therapists. An active approach to the patient and early mobilisation ensured quick stabilisation of the patient.

The patient stopped taking therapy for type 2 diabetes, stabilisation of blood pressure and pulse was observed. There were no post-operative complications. 

Before undertaking the operation, the surgeons visited the Sisters of Mercy Hospital in Zagreb, Croatia, in order to train by taking active participation in bariatric procedures. Over a 12-month period, they observed, assisted at, and analysed all bariatric operations at the hospital. They also participated in workshops at the Aesculap Academy, worked with mentors at UCC Tuzla, and followed ASMBS guidelines.


Bekavac-Beslin also highlighted the importance of teaching the public about bariatric surgery, particularly in countries like Bosnia and Herzegovina where the development of the specialty is still in its initial stages.

The entire multidisciplinary team appeared in Bosnian media for several months, appearing on local and national television and radio promoting the efficacy of surgery in the treatment of morbid obesity.


Bekavac-Beslin also expressed satisfaction that the surgical team was able to perform the first biliopancreatic diversion performed in Bosnia and Herzegovina, and that it was successfully performed by the team with no complications.

He concluded by saying that the team made the right choice of operation, and that the case report shows that biliopancreatic diversion can be the first bariatric procedure if bariatric surgery is developing in a tertiary surgical centre.

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