The weight loss surgeons at the New Life Center are skilled with every major type of bariatric surgery technique, including those that are known to be very complex and not offered by most surgeons.
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. Dr. Boyce has trained hundreds of surgeons in the United States and abroad on how to perform this operation and how to care for the patient afterwards.
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.
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.
Our doctors work diligently to minimize risks from this procedure. When you come in for your initial consultation, our bariatric surgeon will explain all risks and benefits of BPD/DS and determine whether this procedure or an alternative treatment is more ideal for your needs.
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.
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.
Most centers do not 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.
Physicians Plaza 1, Suite 305
Turkey Creek Medical Center
10810 Parkside Drive
Knoxville, TN 37934