Biliopancreatic Diversion with Duodenal Switch

After a sleeve gastrectomy is created, the small intestine is divided, and a connection is made near the bottom of the stomach and near the end of the small intestine.

The Procedure

The duodenum, or the first portion of the small intestine, is divided just past the stomach outlet. A segment of the distal (last portion) small intestine is then brought up and connected to the outlet of the newly created stomach so that when the patient eats, the food goes through a newly created tubular stomach pouch and empties directly into the last segment of the small intestine. Roughly three-fourths of the small intestine is bypassed by the food stream.

The bypassed small intestine, which carries the bile and pancreatic enzymes necessary for the breakdown and absorption of protein and fat, is reconnected to the last portion of the small intestine to mix with the food stream eventually. Similar to the other surgeries described above, the BPD/DS initially helps to reduce the amount of food consumed; however, over time, this effect lessens, and patients can eventually consume near “normal” amounts of food. Unlike the other procedures, there is a significant amount of small bowel that is bypassed by the food stream.

Additionally, the food does not mix with the bile and pancreatic enzymes until very far down the small intestine. This results in a significant decrease in the absorption of calories and nutrients (particularly protein and fat) and nutrients and vitamins dependent on fat for absorption (fat-soluble vitamins and nutrients). Lastly, the BPD/DS, similar to the gastric bypass and sleeve gastrectomy, affects gut hormones in a manner that impacts hunger and satiety as well as blood sugar control. The BPD/DS is considered to be the most effective surgery for the treatment of diabetes among those that are described here.

Advantages

Results in more significant weight loss than other surgeries: 60 to 70 percent excess weight loss or greater at 5-year follow-up.Reduces the absorption of fat by 70 percent or more.
Causes favorable changes in gut hormones to reduce appetite and improve satiety.
It is the most effective against diabetes compared to other surgeries.

Disadvantages

Has a higher complication rate and risk for mortality than the sleeve gastrectomy and gastric bypass.
It may require a more extended hospital stay.
It has a greater potential to cause protein and long-term deficiencies in several vitamins and minerals (iron, calcium, zinc, and fat-soluble vitamins A, D, E, and K).
Compliance with follow-up visits and care and strict adherence to dietary and vitamin supplementation guidelines are critical to avoiding serious complications from protein and certain vitamin deficiencies.