What is a Biliopancreatic Diversion with Duodenal Switch?

This biliopancreatic diversion with duodenal switch procedure results in decreased absorption of fat, calories and other nutrients which may result in increased weight-loss. Foods high in fat content are not easily absorbed and will be eliminated along with the usually high calories associated with the high-fat.

In all bariatric surgery procedures, carbohydrates and sugars are absorbed, so eating foods high in sugar (and calories) will still cause unwanted weight gain or difficulty to lose weight. Additionally, emphasis is placed on nutritionally beneficial and nutrient dense foods. The BPD/DS allows patients to increase portion size throughout, allowing for greater diversity in food consumption at each meal.

How is the Biliopancreatic Diversion with Duodenal Switch performed?

The outer margin of the stomach is removed (approximately two thirds—similar to a sleeve gastrectomy) and the intestines are then rearranged so that the area where the food mixes with the digestive juices is shortened.

A portion of the stomach is then left with the pylorus still attached and the duodenum beginning at its end. The duodenum is then divided, allowing for the pancreatic and bile drainage to be bypassed. This procedure preserves the pylorus, which eliminates “dumping syndrome” that can occur with gastric bypass.

• These operations often result in a high degree of patient satisfaction because patients are able to eat larger meals than with a purely restrictive or standard Roux-en-Y gastric bypass procedure.
• These procedures can produce the greatest excess weight loss because they provide the highest levels of malabsorption.
• In one study of 125 patients, excess weight loss of 74% at one year, 78% at two years, 81% at three years, 84% at four years, and 91% at five years was achieved.
• Long-term maintenance of excess body weight loss can be successful if the patient adapts and adheres to a straightforward dietary, supplement, exercise and behavioral regimen.

Risks

• For all malabsorption procedures there is a period of intestinal adaptation when bowel movements can be very liquid and frequent. This condition may lessen over time, but may be a permanent lifelong occurrence.
• Abdominal bloating and malodorous stool or gas may occur.
• Close lifelong monitoring for protein malnutrition, anemia and bone disease is recommended. As well, lifelong vitamin supplementing is required. It has been generally observed that if eating and vitamin supplement instructions are not rigorously followed, at least 25% of patients will develop problems that require treatment.
• Changes to the intestinal structure can result in the increased risk of gallstone formation and the need for removal of the gallbladder.
• Re-routing of bile, pancreatic and other digestive juices beyond the stomach can cause intestinal irritation and ulcers.