Biliopancreatic Diversion/ Duodenal Switch
Open/Laparoscopic Biliopancreatic Diversion with or without Duodenal Switch
Our Manhattan bariatric surgery team may recommend an open BPD-DS instead of a laparoscopic procedure, depending on the patient’s BMI and co-morbidities. Additionally, a larger incision may be necessary if a laparoscopic BPD-DS cannot be completed using small incisions. Although the BPD-DS operation involves removing part of the stomach, it leaves a significant portion of it intact, including the pyloric valve which regulates the passage of stomach contents into the small intestine. The intestines are re-routed to a greater degree than in the gastric bypass procedure. An “alimentary limb” is created by dividing the small intestine and attaching one end to the small stomach pouch. This provides a digestive path which completely bypasses most of the small intestine. Digestive juices from the pancreas and stomach travel through the “biliopancreatic limb” and do not mix with ingested food until the two limbs join to form a common limb close to the colon.
Initial weight loss occurs because patients eat less, and long-term weight loss occurs because fat and carbohydrates are not completely absorbed, but sugars are. This procedure provides the most malabsorption of the weight loss procedures. This is an operation that was popularized in Italy and later modified by surgeons in the US and Canada. Weight loss results are excellent with patients losing up to 82% of their excess weight as far out as 12 years. However, this weight loss is accompanied by a much greater risk of malnutrition, malodorous flatulence, and loose stools.
- This procedure offers maximal weight loss which can be maintained long-term.
- Patients can eat normally after a while because the capacity of the stomach is greater than a gastric bypass.
- Dumping syndrome does not occur with this surgery.
- Leaks and infection can occur from where the intestines are re-routed or where part of the stomach is removed.
- A narrowing can occur where the duodenum is connected to the intestine.
- A wound infection can occur in the incision which may require further therapy.
- Pancreatitis or inflammation of the pancreas can occur which can be severe.
- Protein malnutrition occurs 3-10% of the time which may require hospitalization
- Vitamin, calcium and iron deficiencies can also occur.
- Patients experience 4-10 foul smelling bowel movements initially after the surgery and 3-6 per day for the rest of their lives
- A hernia may develop in the incision site that will require further surgery to repair.
- This procedure is not reversible.
Please attend one of our Educational Seminars to learn more.