Biliopancreatic Diversion

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How a Biliopancreatic Diversion with Doudenal Switch (BPD-DS) Works to Help You Lose Weight

BPD-DS is one of the least commonly performed procedures for morbid obesity in the U.S.   It  combines restrictive and malabsorptive elements to achieve and maintain the best reported long-term percentage of excess weight loss among modern weight-loss surgery procedures.  The BPD-DS procedure includes a vertical sleeve grastrectomy, which reduces the stomach along the lesser curve of the stomach, effectively restricting its capacity thereby limiting food intake.  In addition due to the removal of a large percentage of the stomach, it was been shown that certain levels of hunger hormones are reduced which limits a patients desire/drive to eat.  The malabsorptive component of the BPD/DS procedure rearranges the small intestine to separate the flow of food from the flow of bile and pancreatic juices much like the gastric bypass. However, unlike the gastric bypass the divided intestinal paths are rejoined much further down stream (common channel is much shorter then the gastric bypass) which results is significantly more malabsorption then the gastric bypass.

BPD-DS Benefits

Improvements in health, quality of life, and, of course, significant weight loss are important bariatric surgery benefits.  In addition to these benefits multiple studies have demonstrated long term cost savings due to reduced medical care and related expenses.

Improvement or resolution of many serious health problems: In a clinical study, the BPD-DS reduced the total number of serious health problems (known as comorbid conditions or comorbidities) of participating patients by nearly 100%.  Significant improvements or complete resolution of patients medical problems are expected even with a modest amount of weight loss and are often seen very quickly seen after surgery if not right away.

Quality of Life Improvements:Clinical studies of  BPD-DS surgery patients found that they felt better, spent more time doing recreational and physical activities, benefited from enhanced productivity and economic opportunities, and had more self-confidence than they did prior to surgery.

Significant weight loss after bariatric surgery: As a result  BPD-DS, patients typically lose more then 85% of their excess body weight in the first year following surgery with the best long term weight loss maintenance.

Weight loss surgery cost savings over time:A recent study showed that bariatric surgery pays for itself in about 2 years.  One important reason is that weight loss surgery may help to improve or resolve conditions associated with obesity, such as type 2 diabetes and high cholesterol, so patients save money on related prescription drugs, doctor visits, and hospital visits.

BPD-DS Procedure

Like all other bariatric procedures that we perform, the BPD-DS is done laparoscopically.  In this operation the majority of the stomach is removed along the lesser curve creating a long narrow tube of stomach about the size of a garden hose.  The small intestine is then divided just beyond the pylorus (near the stomach) and also about 400 cm from the colon.  The lower end of intestine 400 cm from the colon is then attached to the doudenum near the stomach and the limb of intestines from the liver/pancreas carring the digestive enzymes is attached back to the small intestine about 150 cm from the colon (common channel).

BPD-DS Risks and Related Complications

As with any surgical procedure, potential risks and complications can occur with gastric bypass. We’re committed to providing you with the information you need to make a well-informed decision about your surgery. Although these problems rarely occur, we want you to know the facts.  Due to the significant number of procedures now performed and the development of Centers of Excellence, surgical weight loss is infact some of the safest surgical abdominal operations performed today.  Prior to considering any weightloss procedure you should be familiar with all of these potential risks.  Some of the more salient risks are list below.  For a more complete list of risk please review the gastric bypass consent form posted on our forms page.

Potentially serious complications:

  • Perforation of stomach/intestine or leakage, causing peritonitis or abscess
  • Internal bleeding requiring transfusion or reoperation
  • Spleen injury requiring removal/other organ injury
  • Gastric outlet or bowel obstruction
  • Blood clots (DVT) with or without pulmonary embolus (PE)
  • Death
  • Increased risk of malnutrition compared to the Gastric Bypass:
    • Malabsorption of fat soluble vitamins (Vitamins A, D, E, and K)
    • Vitamin A deficiency, which causes night blindness
    • Vitamin D deficiency, which causes osteoporosis
    • Iron deficiency –a similar incidence with the RYGBP
    • Protein-calorie malnutrition, which might require a second operation to lengthen the common channel

Other complications generally considered minor:

  • Minor wound or skin infection/scarring, deformity, loose skin
  • Vomiting or nausea/inability to eat certain foods/improper eating
  • Inflammation of the esophagus (esophagitis), acid reflux (heartburn)
  • Diarrhea and foul smelling gas, with an average of 3-4 loose bowel movements a day
  • Development of gallstones or gallbladder disease
  • weight gain, failure to lose satisfactory weight
  • Intolerance to refined sugars (dumping), with nausea, sweating, weakness (less frequent then the bypass)
  • Ulcers (less frequent with DS then the bypass)

Things to Consider

  • BPD-DS surgery should not be considered until you and your doctor have evaluated all other options.
  • Weight loss surgery is not cosmetic surgery. The procedures do not involve the removal of fatty tissue by cutting or suction.
  • The success of weight loss surgery is dependent on long-term lifestyle changes in diet and exercise.
  • A decision to elect surgical treatment for weightloss requires an assessment of the benefits and risks as well as the meticulous performance of the appropriate surgical procedure by an experienced bariatric surgeon associated with a center of excellence hospital/program.
  • Patients with significantly higher BMIs (>60) maybe better suited for the BPD-DS due to the greater expected weight loss
  • Malabsorption and subsequent malnutrition and micro-nutrient deficiencies is significantly greater then the gastric bypass and the need to take different nutritional supplements is imparitive.
  • Life-long monitoring is necessary to prevent nutritional and mirconutrient deficiencies

If you’re considering BPD-DS surgery, we encourage you to attend one of our free weight loss surgery information seminars.  You’ll learn about the risks and benefits of surgical weight loss options, you’ll meet bariatric team members who will support you before and long after your surgery, and you may also hear from patients who have had weight loss surgery. There’s no pressure to make a commitment—and no better way to get the answers you’re looking for. Of course, family and friends are welcome, too.

Want to talk it over? We’re ready to help. Call our office at 706-481-7298 and one of our staff members experienced in all aspects of weightloss surgery will be happy to answer your questions.