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Learn about Biliopancreatic Diversion

The Biliopancreatic Diversion with Duodenal Switch – abbreviated as BPD/DS – involves two procedures as part of the surgery. First, a smaller, tubular stomach pouch is created by removing a portion of the stomach, which is a 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 your 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 that 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 who have the procedure are able to consume near “normal” amounts of food.

Additionally with this procedure food does not mix with the bile and pancreatic enzymes until further down the small intestine. This results in 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).

BPD/DS affects gut hormones in a manner that impacts hunger and satiety as well as improving blood sugar control. The BPD/DS is considered to be the most effective surgery for the treatment of diabetes.


BPD/DS allows a patient to lose more weight than the other three 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 following surgery.

  • 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
  • Is the most effective against diabetes compared to compared to  Adjustable Gastric Band, Laparoscopic Sleeve Gastrectomy  and Roux-en Y Gastric Bypass

Potential Concerns

The BPD/DS surgery can have more complications that result due to the complexity of the surgery. It can also cause a shortage of vitamins, minerals and protein that your body needs to be healthy.

  • Has 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 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.

Patients who have the following conditions are not ideal for this surgery.

  • Have vitamin or mineral deficiencies (including anemia)
  • Suffer from Crohn’s disease
  • Have had many past abdominal surgeries
  • Have irritable bowel syndrome and frequent diarrhea
  • Have severe acid reflux

What to expect following  the surgery -  Recovery can take two to four weeks on average depending on overall health condition, job restrictions and patient compliance to post-operative instructions.

WakeMed’s dedicated bariatric surgeons perform minimally invasive weight loss surgeries at WakeMed Cary Hospital, an accredited MBSAQIP Comprehensive Center.  WakeMed Cary Hospital is also designated a Cigna Center of Excellence in Bariatric Surgery and a Blue Cross and Blue Shield of North Carolina (BCBSNC) Blue Distinction Center for Bariatric Surgery.