Biliopancreatic Diversion With Duodenal Switch

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Biliopancreatic Diversion With Duodenal Switch


Biliopancreatic Diversion with Duodenal Switch, or BPD-DS, is a restrictive/malabsorptive surgical procedure. It is restrictive in the sense that it “restricts” how much food the stomach can hold and is “malabsorptive” in that it affects how food and calories are absorbed into the bloodstream. This combination surgery has the highest success rate for amount of weight lost.

BPD-DS surgery, a modification of BPD surgery, combines a sleeve gastrectomy (removal of part of the stomach) with a long intestinal bypass. In the sleeve gastrectomy part of the surgery, the outer margin of the stomach is removed, leaving a banana shaped stomach, ¼ of its original capacity, that remains connected to the duodenum. This creates the restrictive portion of the surgery.

The second part of BPD-DS surgery involves rearranging the small intestine so food does not mix with bile and pancreatic juices until the distal end of the small intestine. This creates the malabsorption part of the surgery.

The surgeon accomplishes this by dividing the first part of the duodenum between the stomach and bile duct and closing off the divided end. The surgeon then divides the small intestine about half way down, connecting the lower portion to the open end of the duodenum. This segment is referred to as the digestive, or roux, limb. The remaining end of the small intestine is reconnected 75-100 cm from the large intestine creating the “common channel” allowing for bile and pancreatic juices to flow and mix with the food at the distal end of the small intestine, instead of in the duodenum, thereby limiting absorption of nutrients and calories.

Advantages of BPD-DS Surgery include:

  • Excellent long term weight loss results
  • Unrestricted diet
  • Able to eat larger portions of food than “pouch” surgeries
  • Pyloric valve is left intact essentially eliminating “Dumping Syndrome”
  • Normal stomach function is maintained but in a smaller capacity
  • Reduced incidence of stomal ulcers due to removal of most of the acid secreting cells in stomach
  • Continued weight loss for 18-24 months post-surgery
  • Many patients maintain a weight loss of 75-80% of excess weight 10 years post-op
  • Improved health problems associated with severe obesity (i.e. Diabetes, high blood pressure, sleep apnoea, etc.) Improved mobility and quality of life

Disadvantages of Biliopancreatic Diversion Surgery include:

  • Most complicated of currently available obesity surgeries
  • Limited number of surgeons performing this procedure via laparoscopy.
  • Usually performed as open operation instead of Laparoscopically, with associated risks
  • Risk of death 1:100 surgeries
  • Longer recovery time, usually 6-8 weeks
  • Potential for protein malnutrition
  • Malabsorption requires lifelong supplementation of fat soluble vitamins (A, D, E, and K), B12, calcium, and iron.
  • Requires permanent lifelong changes to patient’s diet and lifestyle. Lifelong follow up with physician required
  • Risk of iron deficiency anaemia and osteoporosis if supplements not taken
  • Requires gallbladder removal during surgery due to high risk of gallstones
  • Not possible to fully reverse due to partial removal of stomach
  • Increased stool frequency to 2-4/day Foul flatulence and diarrhoea if fatty foods eaten

Risks & Complications

  • As with any surgery there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages.
  • It is important that you are informed of these risks before the surgery takes place.

Most patients do not have complications after BPD-DS surgery; however complications can occur and depend on the patient’s health status.

Complications can be medical (general) or specific to BPD-DS.

Medical complications include those of the anaesthesia and your general wellbeing. Almost any medical condition can occur so this list is not complete. Complications include:

  • Allergic reaction to medications
  • Blood loss requiring transfusion with its low risk of disease transmission
  • Heart attack, strokes, kidney failure, pneumonia, bladder infections
  • Complications from anaesthesia
  • Serious medical problems can lead to on-going health concerns, prolonged hospitalization, or rarely death. (less than 1% cases)

Specific complications for BPD-DS include:

  • DVT (blood clot in the deep leg veins)
  • Damage to adjacent organs especially spleen, pancreas and bile duct
  • Abdominal hernia
  • Leakage of digestive contents can lead to serious infection