The biliopancreatic diversion with duodenal switch procedure (also referred to here as BPD-DS or duodenal switch) is somewhat similar to the Roux-en-Y gastric bypass procedure in that it restricts stomach size, thereby limiting the amount of food that can be consumed, and reroutes the intestines to both limit the amount of food absorbed and alter the body’s metabolism.
While the duodenal switch procedure is perhaps one of the most complex and technical bariatric surgeries, it is also arguably the most effective (see below).* The procedure takes about three-and-a-half to four hours to complete in our East Valley bariatric facilities, depending on the surgeon and the patient’s unique risks and anatomy. It is usually done laparoscopically.
During the procedure, approximately 70% of the stomach is removed, creating a new stomach size and shape. The stomach connects the esophagus to the top part of the small intestine. The surgeon then cuts the top of the small intestine, while leaving a portion of the duodenum where digestive chemicals make their way into the process. Another cut is made further down the small intestine (closer to where it meets the large intestine) and this part is connected to the duodenum. The loose part of the small intestine is attached to the small intestine at the bottom, allowing digestive chemicals from the duodenum to enter into the digestive process in the final stretch of the small intestine.
This complex procedure is so effective because of its combined restrictive and malabsorptive properties. Restriction of the stomach size means less food can be eaten. The malabsorptive aspect of the procedure comes about by shortening the small intestine, as well as reducing the amount of time food interacts with digestive chemicals.
The Most Effective Weight Loss Surgery?
The duodenal switch procedure has a reputation for resulting in more weight loss than any other surgical weight loss procedure. According to one study, 84.2% of patients who had this procedure experienced at least 50% loss of excess weight three years post-op.* For the sake of comparison, only 59.3% of patients who had Roux-en-Y gastric bypass surgery experienced the same amount of weight loss three years after their procedure. While the duodenal switch procedure is a highly effective weight loss surgery, it is not the best option for everyone. Learn more below.
Is Biliopancreatic Diversion With Duodenal Switch Right for You?
This procedure can be an excellent option for many obese patients who want to lose a significant amount of weight. BPD-DS is proven to be effective in improving type 2 diabetes, high cholesterol, sleep apnea, hyperlipidemia and hypertriglyceridemia. Improving these conditions can, in turn, improve hypertension and other conditions. So, why would patients at The Bridges Center choose any other weight loss procedure?
The duodenal switch may not be a good option for patients who suffer from gastroesophageal reflux disease (GERD) or inflammatory bowel disease (IBD). Your weight loss surgeon at The Bridges Center can tell you more. It also may not be a good option for patients who do not strictly follow their doctors’ orders. If you know that it will be difficult to commit to taking bariatric vitamins and other medications for the rest of your life after this procedure, then BPD-DS may not be for you. Lastly, vegetarians and anyone else committed to a diet that could be low in protein when portions are restricted should talk to their health care team at The Bridges Center before committing to this procedure.
What Are the Benefits of Duodenal Switch?
Potential benefits of duodenal switch include:
- Greater weight loss. Numerous studies have shown that patients have better success with weight loss using the BPD-DS procedure than other bariatric procedures.*
- Better resolution of comorbidities. On the whole, patients who undergo BPD-DS have superior resolution of comorbidities compared to patients who undergo other bariatric procedures.
- Greater dietary freedom. Most patients who undergo biliopancreatic diversion are able to eat whatever they want. Vomiting is rare with this procedure.
What Risks Are Associated With The Procedure?
There are several risks associated with BPD-DS. In addition to all the potential risks and complications that accompany laparoscopic surgery, patients should be aware of the following risks:
- Leaks (Remember, a large portion of the stomach is resected. The stomach is stapled back together. The small intestine is resected at multiple sites.)
- Blood clots in the legs with risk of pulmonary embolus, which can travel to the lungs
- Bowel obstruction
- Slow-healing or difficult-to-heal incisions
- Kidney failure
- Intraoperative spleen injury
BPD-DS has the highest potential for complications of all surgical weight loss procedures because it is much more involved than other bariatric procedures done at The Bridges Center. Long-term risks, common to weight loss surgery, include anemia, osteoporosis, and vitamin/mineral deficiencies, included–but not limited to–protein, calcium and vitamins D and A. Be prepared to take as many as 10 to 15 pills per day for the rest of your life if you undergo this procedure; otherwise, you may risk serious vitamin deficiency. As a patient at The Bridges Center, you will be prepared with all the information you need in advance so that you have a full understanding of the post-operative diet and lifestyle expected of you.
Can a Biliopancreatic Diversion With Duodenal Switch Be Reversed?
The term “reversal” is not quite right, as there is no way to completely “reverse” the procedure. A BPD-DS procedure can be revised, however. The good news is that fewer than 5% of all duodenal switch procedures require revision surgery. The main reasons a patient would want a revised BPD-DS include excessive weight loss, malnutrition or vitamin deficiencies that the patient is unable or unwilling to manage through supplements. In the case of a patient who has experienced excessive weight loss, the common limb and food limb may be lengthened through revision surgery.
It is more often the case that patients who have had other types of bariatric surgeries have their procedure converted to a duodenal switch. Vertical sleeve gastrectomy may be the easiest procedure to convert to BPD-DS, as the initial component of BPD-DS is quite similar to VSG.
What Happens After The Procedure?
Patients typically remain in the hospital for two to three days following the procedure. During this time, your East Valley weight loss surgeon will check to make sure there are no staple leaks in the stomach. Patients will be kept on a clear liquid diet during this time. It’s important to drink very slowly as you adjust to your new stomach size. The stomach has a significantly reduced capacity at this point, which takes some time getting used to. Over time, the stomach will stretch slightly, allowing for larger portions.
Life After Duodenal Switch
Most patients experience rapid and substantial weight loss for 12 to 18 months after surgery.* Around 12 months, many patients experience “pouch maturation,” a time when the stomach has stretched as much as it is going to stretch, allowing patients to eat meals approximately half or two-thirds the size of the meals they ate prior to surgery.
Many patients will have no weight regain during the three to five years following their BPD-DS procedure. After these first few years, however, weight regain is possible if you do not stay committed to your diet and exercise plan. This is partly due to the stretched capacity of the gastric sleeve.
One benefit of the duodenal switch is that patients are usually able to eat larger meals and a greater variety of foods that are not possible for patients who undergo other surgical weight loss procedures. Bread, pasta, steak, high-fiber vegetables and dense proteins can usually be consumed without much difficulty–which is not to say these foods should be consumed, as they can contribute to weight regain and uncomfortable bowel movements.
Weight Loss Surgery In Phoenix & Mesa, AZ
To learn more about biliopancreatic diversion with duodenal switch–and other surgical weight loss options in the East Valley–we invite you to attend a webinar or seminar at The Bridges Center. Learn about…
- Obesity and its health risks
- The Bridges Center’s proven program
- Our professional health care team
- Your weight loss surgery options in Phoenix and Mesa, AZ
To register for a seminar, call 602-251-8828 or select the link below.