Biliopancreatic diversion with a duodenal switch (BPD/DS), also called the “duodenal switch” or the “switch” for short, is a surgical weight loss procedure utilizing both restrictive and malabsorptive methods to achieve long-term weight loss. BPD/DS surgery is usually restricted to super morbidly obese individuals who might also have some of the following problems:
- Obstructive Sleep Apnea
- Diabetes Mellitus
Biliopancreatic Diversion with a Duodenal Switch (BPD/DS) Procedure
The surgery is usually performed laparoscopically. The BPD/DS procedure first involves the removal of approximately 1/2 to 2/3 of the stomach. The stomach is left as a small tube (the restrictive part of the surgery), and the area more responsible for the release of ghrelin (“hunger hormone”) is removed. The pyloric valve, which controls the release of food from the stomach into the small intestine, is kept intact. This intact and functional valve is very important to help prevent the “dumping” syndrome. This is a set of symptoms (abdominal pain, nausea, diarrhea) quite common with other bypass surgeries particularly associated with ingestion of too many simple sugars.
The small intestine is divided into two parallel channels. The duodenum (the initial part of the small intestine, just after the pyloric valve leaving the stomach) is first joined to the end of the small bowel, about 20 inches from the large intestine, or colon. In the second part of the small bowel surgery, the rest of the small bowel attached to the gall bladder and pancreas is then joined to the first part about 6 inches above the entrance to the large bowel, forming a “common channel”. In this way, the enzymes from the gall bladder and pancreas responsible for the digestion of food are exposed to the food for a much shorter distance, resulting in less nutrients being absorbed by the gut. This is the malabsorptive part of the procedure
Because this surgery is associated with the most malabsorption of weight loss surgeries, there is some controversy associated with it because of the high risk of associated malnutrition. These patients, while showing excellent long-term weight loss, will need life-long monitoring of their nutritional status.
Advantages of biliopancreatic diversion with a duodenal switch surgery (BPD/DS):
- Ability to eat normal food and drink, but feel full faster (as a result of a smaller stomach)
- Long-term weight loss occurs particularly for patients with a higher BMI (BMI of 55 or more)
- Studies suggest an 85% loss of excess weight after a year
- Reduced chance of developing an ulcer
- Virtually eliminates dumping syndrome, since the pyloric valve remains intact.
- Lower long-term costs of medications to treat problems associated with obesity, such as diabetes and high cholesterol
- Improvement in quality of life, with patients becoming more physically active and economically benefitted
Disadvantages/risks of biliopancreatic diversion with a duodenal switch (BPD/DS):
- Chance of a hernia where the surgical incision was
- Higher chance of chronic diarrhea and foul smelling flatulence
- Inability to absorb enough vitamins and minerals to maintain proper nutritional levels
- Possible surgical complications due to the complexity of the surgery (more frequent in high risk patients with sleep apnea, heart disease, etc.)
- Risk of nutritional deficiencies leading to possible anemia, protein deficiency, or metabolic bone disease