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Biliopancreatic Diversion

Biliopancreatic Diversion

Biliopancreatic diversion with duodenal switch (BPD/DS) causes favorable changes in gut hormones in a way that impacts hunger and satiety as well as improves a patient’s blood sugar control. BPD/DS is considered to be the most effective surgery for the treatment of diabetes compared to other bariatric surgery options.

Highlights

  • Results in greater weight loss compared to adjustable gastric band, laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass
  • Allows patients to eventually eat near “normal” meals
  • Reduces the absorption of fat by 70 percent or more
  • Causes favorable changes in gut hormones to reduce appetite and improve satiety

What to Expect

Biliopancreatic diversion with duodenal switch involves two procedures. First, a smaller, tubular stomach pouch is created by removing a portion of the stomach, similar to the sleeve gastrectomy surgery. The second procedure involves bypassing a major portion of the small intestine so that food can be redirected to the end of the small intestine.

The bypassed small intestine, which carries the bile and pancreatic enzymes that are necessary for the breakdown and absorption of protein and fat, is reconnected to the latter portion of the small intestine so these enzymes can eventually mix with the food stream.

BPD/DS initially helps by reducing the amount of food that is consumed; however, over time people are able to consume near “normal” amounts of food.

Also, since food does not mix with the bile and pancreatic enzymes until further down the small intestine, there is a significant decrease in the absorption of calories and nutrients (particularly protein and fat) as well as nutrients and vitamins dependent on fat for absorption (fat soluble vitamins and nutrients).

Results

BPD/DS allows a patient to lose more weight than other more common types of bariatric surgery. Studies have shown that people who have this procedure experience 60 to 70 percent excess weight loss or greater at the five-year mark after surgery.

Potential Concerns

BPD/DS surgery can have complications due to the complexity of the surgery. It can also cause a shortage of vitamins, minerals and protein that the body needs to stay healthy. Potential concerns include:

  • Higher complication rates and risk for mortality than adjustable gastric band, laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass.
  • Requires a longer hospital stay (2-3 days)[EH1]  for recovery than the adjustable gastric band and laparoscopic sleeve gastrectomy.
  • Has a greater potential to cause protein deficiencies and long-term deficiencies in a number of vitamin and minerals such as iron, calcium, zinc and fat-soluble vitamins like vitamin D. As a result, the patient is required to consume a higher amount of protein following surgery.
  • People who have had the BPD/DS must be compliant with follow-up visits and strict dietary directives provided by their physicians.

This Surgery May Not Be Right for You

If you have these conditions, this surgery may not be right for you: 

  • Vitamin or mineral deficiencies (including anemia)
  • Crohn’s disease
  • Many past abdominal surgeries
  • Irritable bowel syndrome and frequent diarrhea
  • Severe acid reflux

What to Expect After Surgery

Recovery can take two to four weeks on average depending on a patient’s overall health condition, job restrictions and patient compliance to post-operative instructions.