Duodenal switch with biliopancreatic diversion

Overview

A biliopancreatic diversion with duodenal switch (BPD/DS) is a less-common weight-loss procedure that entails two major steps.

The first step is sleeve gastrectomy in which about 80 percent of the stomach is removed, leaving a smaller tube-shaped stomach, similar to a banana. However, the valve that releases food to the small intestine (the pyloric valve) remains, along with a limited portion of the small intestine that normally connects to the stomach (duodenum).

The second step bypasses the majority of the intestine by connecting the end portion of the intestine to the duodenum near the stomach. A BPD/DS both limits how much you can eat and reduces the absorption of nutrients, including proteins and fats.

BPD/DS is generally performed as a single procedure; however, in select circumstances, the procedure may be performed as two separate operations — sleeve gastrectomy followed by intestinal bypass once weight loss has begun.

While a BPD/DS is very effective, it has more risks, including malnutrition and vitamin deficiencies. This procedure is generally recommended for people with a body mass index (BMI) greater than 50.

The duodenum, or the first portion of the small intestine, is divided just past the outlet of the stomach. A segment of the distal (last portion) small intestine is then brought up and connected to the outlet of the newly created stomach, so that when the patient eats, the food goes through a newly created tubular stomach pouch and empties directly into the last segment of the small intestine. Roughly three-fourths of the small intestine is bypassed by the food stream.

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 last portion of the small intestine so that they can eventually mix with the food stream. Similar to the other surgeries described above, the BPD/DS initially helps to reduce the amount of food that is consumed; however, over time this effect lessens and patients are able to eventually consume near “normal” amounts of food. Unlike the other procedures, there is a significant amount of small bowel that is bypassed by the food stream.

Additionally, the food does not mix with the bile and pancreatic enzymes until very far 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). Lastly, the BPD/DS, similar to the gastric bypass and sleeve gastrectomy, affects guts hormones in a manner that impacts hunger and satiety as well as blood sugar control. The BPD/DS is considered to be the most effective surgery for the treatment of diabetes among those that are described here.

Why it's done

A BPD/DS is done to help you lose excess weight and reduce your risk of potentially life-threatening weight-related health problems, including:

Heart disease
High blood pressure
High cholesterol
Severe sleep apnea
Type 2 diabetes
Stroke
Infertility

Risks

As with any major surgery, a BPD/DS poses potential health risks, both in the short term and long term.

Risks associated with BPD/DS are similar to any abdominal surgery and can include:

Excessive bleeding
Infection
Adverse reactions to anesthesia
Blood clots
Lung or breathing problems
Leaks in your gastrointestinal system

How you prepare

If you qualify for a BPD/DS, your health care team gives you instructions on how to prepare for surgery. You may need to have various lab tests and exams before surgery.

During the procedure

The specifics of your surgery depend on your individual situation and your doctor's practices. Some surgeries are done with traditional large, or open, incisions in your abdomen, while some may be performed laparoscopically, which involves inserting instruments through multiple small incisions in your abdomen.

The first step of a BPD/DS.The first step in a BPD/DS involves removing a portion of the stomach. After making the incisions with the open or laparoscopic technique, your surgeon removes a large portion of the stomach and forms the remaining portion into a narrow sleeve. Your surgeon leaves intact the valve that releases food to the small intestine (the pyloric valve), along with a limited portion of the small intestine that normally connects to the stomach (duodenum).
The second step of a BPD/DS.During the second step, your surgeon makes one cut through the part of the small intestine just below the duodenum, and a second cut farther down, near the lower end of the small intestine. Then your surgeon brings the cut end near the bottom of the small intestine up to the other cut end, just below the duodenum. The effect is to bypass a large segment of the small intestine.

What you can expect

BPD/DS is done in the hospital. The length of your hospital stay will depend on your recovery and which procedure you're having done. When performed laparoscopically, your hospital stay may last around two days.

Advantages

Results in greater weight loss than RYGB, LSG, or AGB, i.e. 60 – 70% percent excess weight loss or greater, at 5 year follow up
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 RYGB, LSG, and AGB

Disadvantages

Has higher complication rates and risk for mortality than the AGB, LSG, and RYGB
Requires a longer hospital stay than the AGB or LSG
Has a greater potential to cause protein deficiencies and long-term deficiencies in a number of vitamin and minerals, i.e. iron, calcium, zinc, fat-soluble vitamins such as vitamin D
Compliance with follow-up visits and care and strict adherence to dietary and vitamin supplementation guidelines are critical to avoiding serious complications from protein and certain vitamin deficiencies

10 common question about Duodenal switch with biliopancreatic diversion

1Does duodenal switch cause diarrhea?

Diarrhea or loose stools is mainly a potential side effect of Sleeve Gastrectomy with Duodenal Switch (also known as Biliopancreatic Diversion with Duodenal Switch). ... This fermentation will result in increased gas and diarrhea. The average patient after the DS has 2-3 soft bowel movements per day.

2How much weight can you lose with the duodenal switch?

Duodenal switch surgery has excellent results, with the average patient losing 70 to 80% of his excess weight in the two years that follow the procedure.

3What is the difference between gastric bypass and duodenal switch?

During a gastric bypass, a surgeon shrinks the size of the stomach by making its upper portion into a smaller pouch and connecting that directly to the small intestine. In comparison, a duodenal switch involves "bypassing" much of the small intestine, where nutrients are absorbed.

4Is a duodenal switch reversible?

Duodenal switch surgery is not reversible, and some people may have complications after the surgery. One of the complications of duodenal switch surgery includes protein, vitamin and mineral deficiencies.

5Is Dumping Syndrome dangerous?

The symptoms range from mild to severe and often subside with time. Although you may find dumping syndrome alarming at first, it is not life threatening. You can control it by making changes in what and how you eat.

6How do you prevent dumping syndrome?

How is dumping syndrome after gastric bypass surgery treated? Don't drink liquids until at least 30 minutes after a meal. Divide your daily calories into 6 small meals. Lie down for 30 minutes after a meal to help control the symptoms. Choose complex carbohydrates such as whole grains.

7What's the best surgery for weight loss?

So how do you decide which one is best for you? New research that compares three types of weight-loss surgery in more than 46,000 patients may help. The three types of surgery included gastric bypass, sleeve gastrectomy and adjustable gastric banding (also known as lap band).

8What is Loop duodenal switch?

Loop duodenal switch (SADI-S) is a new minimally invasive procedure that offers exceptional weight-loss results for people who meet the following criteria: You have a body mass index (BMI) of more than 50 that puts you at high risk for other obesity-related diseases like type-2 diabetes or heart disease.

9What foods can you not eat after gastric bypass surgery?

Soft foods Ground lean meat or poultry. Flaked fish. Eggs. Cottage cheese. Cooked or dried cereal. Rice. Canned or soft fresh fruit, without seeds or skin. Cooked vegetables, without skin.

10Can I have duodenal switch after gastric sleeve?

The duodenal switch, a combination of the gastric sleeve and a bypass of the intestines, however, has demonstrated the best weight loss. ... Now, when sleeve patients require more weight loss, we can complete the duodenal switch.

[kkstarratings]

Duodenal switch with biliopancreatic diversion