How Does Biliopancreatic Diversion with Duodenal Switch (BPD-DS) Work?

BDP-DS is a restrictive and malabsorptive bypass procedure. The restrictive component of BDP-DS is essentially the same as that of sleeve gastrectomy. The stomach is dissected vertically and stapled so that it becomes like a sleeve. This greatly reduces the amount of food that can be eaten. The malabsorptive component involves bypass of the greater part of the small intestine.

Like Roux-en-Y, BDV-DS connects the stomach directly with the lower part of the small intestine, very close to the large intestine. Absorption of nutrients is, however, more compromised than in Roux-en-Y. In addition, unlike Roux-en-Y that excludes the lower part of the stomach from the digestive tract continuity, BPD-DS preserves the lower stomach (including the pyloric valve).

Expected Weight Loss after Biliopancreatic Diversion with Duodenal Switch

BDP-DS patients lose on average 84% of their excess weight within 27 months, according to the 2009 study by Strain and colleagues.

Pros

• Greater and faster weight loss than Roux-en-Y provides.

• Better eating quality. The stomach is bigger and more normal with this procedure than with Roux-en-Y. Patients can eat more. The stomach is more forgiving to deviations from the ideal bariatric eating and allows for better digestion.

• No Dumping Syndrome. The pyloric valve is preserved which prevents dumping syndrome.

• Ideal for super obese. Unlike other weight loss surgeries, BPD-DS is very effective for super obese patients who are otherwise healthy. It is equally effective for less obese people.

Cons

• Very complex. This is the most complex weight loss surgery, and it poses a high risk for obese patients who suffer from other obesity comorbidities (sleep apnea, heart disease, etc)

• Not common. Due to its technical difficulty, only a few surgeons (around 50) globally perform this type of surgery.

• Permanent. Like Roux-en-Y, the surgery changes irreversibly the structure of your digestive system.

Risks and Complications of Biliopancreatic Diversion with Duodenal Switch

• Nutrient Deficiency. Because of the severe malabsorption, anemia, protein and vitamin deficiency can occur. Risk for malnutrition may be higher than that of Roux-en-Y. Malnutrition is preventable with daily vitamin supplementation.

• Gastric leakage, small bowel obstruction and hernia are other potential complications of BPD-DS.

• High death risk. The National Institute of Health states that the death risk for BPD-DS is between 2.5-5.0%.

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