Biliopancreatic Diversion With Duodenal Switch (BPD/DS)

The Biliopancreatic Diversion with Duodenal Switch, abbreviated BPD-DS, begins with the creation of a tube-shaped stomach pouch similar to the sleeve gastrectomy. It resembles the gastric bypass, where more of the small intestine is not used.  Following the creation of the sleeve-like stomach, the first portion of the small intestine is separated from the stomach.  A part of the 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 the sleeve pouch and into the latter part of the small intestine.

The smaller stomach, shaped like a banana, allows patients to eat less food. The food stream bypasses roughly 75% of the small intestine, the most of any commonly performed approved procedures. This results in a significant decrease in the absorption of calories and nutrients. Patients must take vitamins and mineral supplements after surgery. Even more than gastric bypass and sleeve gastrectomy, the BPD-DS affects intestinal hormones in a manner that reduces hunger, increases fullness and improves blood sugar control. The BPD-DS is considered to be the most effective approved metabolic operation for the treatment of type 2 diabetes.

Pros

  • Among the best results for improving obesity

  • Affects bowel hormones to cause less hunger and more fullness after eating

  • It is the most effective procedure for the treatment of type 2 diabetes

Cons

  • Has slightly higher complication rates than other procedures

  • Highest malabsorption and greater possibility of vitamins and micro-nutrient deficiencies

  • Reflux and heartburn can develop or get worse

  • Risk of looser and more frequent bowel movements

  • More complex surgery requiring more operative time

Diagram of Biliopancreatic Diversion With Duodenal Switch