Biliary-Pancreatic Diversion with Duodenal Switch (BPD/DS)

Biliary Pancreatic Diversion with Duodenal Switch is growing in popularity with surgeons because it is a natural revision option for patients that have had weight regain after Sleeve Gastrectomy. Also known as BPD/DS, this procedure can help patients suffering from severe obesity achieve significant weight loss and provide long-term resolutions for a number of obesity-related health conditions.

BPD/DS is basically a combination of a “limited” sleeve gastrectomy with a significant small bowel bypass. It is a limited sleeve gastrectomy because, instead of removing 80% of the stomach as with the Sleeve Gastrectomy surgery, only about 50% of the stomach is removed during BPD/DS. The small bowel bypass is an important component of the surgery because the small bowel is where we absorb our nutrition, such as protein, carbohydrates, and fat, from the food we eat. When you bypass (reroute the bowel so that food only goes through part of the small bowel) over half of the small bowel, you create a situation where a patient’s ability to absorb calories is limited.

After BPD/DS, patients can only absorb 60% of the protein and carbohydrates and only 30% of the fat from a meal. If the patient follows the dietary recommendations then the patient may only absorb 1200-1700 calories per day, even if they consume 3000! This inability to absorb calories helps patients avoid weight regain after surgery.

The operation is performed laparoscopically, using small instruments and incisions to minimize scarring and recovery time. The BPD/DS is particularly advantageous for the super-obese patient (BMI > 50). With other options, the super-obese often fail to lose the desired weight; however, with the BPD/DS, excess weight loss of 85% is common. This operation is also particularly effective for the severely diabetic patient, with long-term diabetes remission rates (95%) that are far superior to the other operations.

How can Biliary Pancreatic Diversion with Duodenal Switch surgery help me achieve my goals?

The PBD/DS is in some ways the most effective weight loss surgical option available.  Like the Sleeve Gastrectomy and the Roux-en-Y gastric bypass, the BPD/DS provides an extended period of time (a year or more) after surgery when the patient really does not feel hungry. This is an effect of alterations in gastrointestinal hormones that occur after surgery. This surgical “anorexia” gives patients an extended period of time to develop new healthy eating habits. When working with our expert multidisciplinary team, it allows patients to lose weight and get healthy by eliminating high blood pressure, sleep apnea, and diabetes. Patients develop healthy eating habits, feel great, and are able to become more active and enjoy life.

Advantages
  • The stomach pouch created in a BPD/BPD with DS procedure is larger than it would be with the other surgical options, such as a gastric bypass. When compared to other procedures, this allows patients to eat larger meals before feeling full, while still losing weight effectively.
  • BPD/DS provides patients with the greatest weight loss, often exceeding 80-85% of excess weight, even in the super-obese.
  • BPD/DS also provides the best resolution of all comorbid conditions, especially diabetes. Diabetic resolution rates of 95% that last for up to 20-25 years have been documented.
  • BPD/DS patients have the LOWEST RATE OF WEIGHT REGAIN! The long-term risk of regaining weight after BPD/DS is approximately 5% (compared to 30% for Sleeve Gastrectomy and 25% for Roux-en-Y gastric bypass).
Risks
  • Following a comprehensive aftercare programs and lifelong monitoring is necessary to watch for anemia, bone disease, and protein malnutrition. People are healthy on a low-carbohydrate, low-fat diet; however, if we do not get the protein our body needs, we cannot survive. Since patients can only absorb 60% of the protein they eat after BPD/DS, then patients MUST eat more protein than they would normally need in order to meet their bodies’ protein needs. For example, if an average woman who needs 60 grams of protein/day has a BPD/DS, she would require at least 100 grams protein/day to meet her nutritional needs after surgery.
  • Patients will also need to take more vitamin supplements after BPD/DS than they would after Sleeve Gastrectomy or Roux-en-Y gastric bypass.
  • Bowel movements may be frequent and more liquid/oily than usual as the intestines adapt after surgery. While these effects may decrease over time, they can also be permanent in some patients. This fatty diarrhea (steatorrhea) is caused by the fat malabsorption. Patients may only absorb about 40 grams of fat/day after surgery. Eating a high-fat diet results in fatty diarrhea. Patients that follow the prescribed diet report having one or two bowel movements daily.
  • Bloating in the abdomen may occur after surgery, which is a result of too many carbohydrates in the diet.

Dr. Williams and our team work diligently to minimize risks from this procedure. When you come in for your initial consultation, Dr. Williams will explain all risks and benefits of BPD/DS and determine whether this procedure or an alternative treatment is more ideal for your needs.

Procedure

Trocars are inserted into the abdominal wall to allow access to the abdominal organs. A Vertical Sleeve Gastrectomy is performed, removing about 50% of the stomach. The duodenum is then divided, preserving the pyloric valve with the remaining stomach. The small bowel is divided and the distal end is connected to the duodenum, creating the “alimentary limb,” eight feet long (food is blue in the video). The proximal end of the small bowel is the “biliopancreatic limb” (biliopancreatic juices are yellow in the video) and it is connected to the alimentary limb three feet from the colon. This creates a “Common Channel” out of the last three feet of the alimentary limb (green is the mixture of the food and biliopancreatic juices). Protein and carbohydrates are absorbed throughout the entire 8 feet of the alimentary channel. Absorption of fat requires bile from the liver, so in the 3 feet of the common channel, absorption of protein, carbohydrates, and fat occurs.

Recovery

Although this is a larger operation than other surgical weight loss procedures, most patients only have a two- to three-day hospital stay. The surgery is performed laparoscopically and requires about one to three hours of operating time, depending on the patient’s history and BMI. The post-operative dietary phases and schedule are the same as with the Gastric Bypass. Patients can typically return to office-style work in two weeks and have unrestricted activity at one month.

Even though the percentage of excess weight loss with other procedures decreases as the BMI increases, patients with BMIs > 50 can often expect excess weight loss of 85%! Because of the outstanding results with the BPD/DS, it is used as a primary operation for patients with a BMI > 50 and as a salvage operation for patients with failed Gastric Bypass, Vertical Sleeve Gastrectomy, and Laparoscopic Adjustable Gastric Bands. Patients must be prepared to follow the prescribed diet and supplements or they may suffer from diarrhea and flatulence and serious nutritional deficiencies.

Not all bariatric centers offer the BPD/DS. If you would like to learn more about this exceptional option, please contact the New Life Center for Bariatric Surgery for a free informational seminar and a consultation.