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Biliopancreatic Diversion with Duodenal Switch
What is the BPD/DS?
The biliopancreatic diversion with duodenal switch surgery, also known as the BPD/DS, is similar to gastric bypass because it involves creating a small stomach pouch and rerouting the intestines. However, the way the intestines are rerouted is slightly different. Like other metabolic surgeries, it changes the amount of food your body can digest, and changes the signals that travel between your digestive system and your brain.
How does BPD/DS work?
- Doctors create a small, tube shaped stomach pouch, and the rest of the stomach is removed
- The small intestine is divided into two parts
- The end of the small intestine is connected to the small pouch, so that food travels directly from the pouch into the last segment of the small intestine (bypassing ¾ of the small intestine)
- The bypassed part of the small intestine, which carries important digestive enzymes, is reconnected to the last part of the small intestine
- Enzymes mix with the food from the pouch to help complete digestion
- Patients eat less food, digest more efficiently, and hormonal signals are changed
- Typical outcomes include weight loss and improvement in metabolic syndrome and overall health and wellbeing
What are the health benefits of the BPD/DS?
- Clinical studies show that patients experience a variety of benefits after surgery
- 94% of patients lost up to 70% excess body weight after 1 year1
- 62% of patients lost 75% excess body weight after 3 years1
- 31% of patients lost 81% excess body weight after 5 years1
- May be the most effective surgery type for treatment of type 2 diabetes2
- Increased physical activity, productivity, well-being, economic opportunities, self-confidence3
- Minimally invasive procedure leads to shorter hospital stays and recovery time
What are some advantages and disadvantages of the BPD/DS?
- Can lead to significant weight loss (94% of patients lost up to 70% excess body weight after 1 year)1
- Can lead to significant improvement of type 2 diabetes2
- Doesn’t use a foreign object (like the gastric band)
- Limits the amount of food that can be eaten, increases efficiency of digestion
- Causes significant changes to digestive organs and hormones that result in reduced hunger and increased metabolism
- Permanent (won’t need more surgeries or readjustments, like the gastric band)
- Requires lifelong dedication to specific diet and exercise routines
- Permanent (cannot be reversed)
- Can lead to vitamin deficiencies
- Possible complication may include:
- Gastric leakage
- Separation of tissue
- Dyspepsia (stomach ache)
- Dumping syndrome
Metabolic and bariatric surgery is as safe or safer than other commonly performed procedures, including gallbladder surgery.4,5 When performed at a Bariatric and Metabolic Surgery Center of Excellence, bariatric and metabolic surgery has a mortality rate of 0.13 percent.4 This means that out of 10,000 people who have this kind of surgery, on average 9,987 will survive surgery and 13 will not.4 Gallbladder removals have a mortality rate of 0.4 percent.5 This means of 10,000 people who have their gallbladder removed, on average 9,960 people will survive surgery and 40 will not.5
All surgeries present risks. These risks vary depending on weight, age, and medical history, and patients should discuss these with their doctor and bariatric and metabolic surgeon.
1. Baltasar A, Bou R, Bengochea M, et al. Duodenal switch: an effective therapy for morbid obesity—intermediate results. Obes Surg. 2001;11:54–58.
2. Nelson, Daniel W. Blair, Kelly S. Martin, Matthew J. Analysis of obesity-related outcomes and bariatric failure rates with the duodenal switch vs gastric bypass for morbid obesity. Archives of Surgery. 147(9):847-54, 2012 Sep.
3. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery. A systematic review and meta-analysis. JAMA. 2004;292(14):1724-1737.
4. DeMaria EJ, Pate V, Warthen M, et al. Baseline data from American Society for Metabolic and Bariatric Surgery-designated bariatric surgery centers of excellence using the bariatric outcomes longitudinal database. Surg Obes Relat Dis. 2010;6(4):347-355.
5. Csikesz N, et al. Current status of surgical management of acute cholecystitis in the United States. World J Surg. 2008 Oct; 32(10):2230-6.