Biliopancreatic diversion with a duodenal switch (BPD/DS), also called the “duodenal switch” or the “switch” for short, is a surgical weight loss procedure utilizing both restrictive and malabsorptive methods to achieve long term weight loss. BPD/DS improves upon the original biliopancreatic diversion which was originally developed by Dr. Scopinaro in Italy and later modified by surgeons in the US and Canada. The malabsorption element in this surgery is more significant than proximal Roux-en-Y gastric bypass.
General Procedure
The BPD/DS procedure involves the reduction of the stomach to a tube (called the sleeve) gastric pouch of 100 to 150 mL volume. This procedure improves on other gastric bypass procedures such as biliopancreatic diversion (BPD) and the usual Roux-en-Y gastric bypass (RNY) by leaving the pyloric valve intact, which regulates the flow of stomach contents into the small intestine. The duodenum is divided a short distance below the pyloric sphincter. More distally, the small intestine is divided, thus an alimentary limb and a biliopancreatic limb are created. The alimentary limb is brought up and is connected to the duodenum and, thus, to the stomach tube. The biliopancreatic limb is attached to the distal intestine, to form a common channel that leads to the colon. Food leaving the stomach sleeve travels through the alimentary limb, thereby avoiding the majority of the small intestine. The biliopancreatic limb is given that name because the common bile duct and the pancreatic duct open into it. Bile and pancreatic juices flow through the biliopancreatic limb and meet with food, that traveled down the alimentary limb, in the common channel.
Among bariatric surgical procedures, BPD/DS is one of the most effective at creating long-term weight loss. It provides the most malabsorption of all weight loss surgeries performed today. For this reason it has been seen as controversial because it carries with it a higher risk of malnutrition and diarrhea. It is important that a patient is monitored closely by a physician on a regular basis to ensure the proper absorption of vitamins and minerals.
Advantages of biliopancreatic diversion with a duodenal switch (BPD/DS):
- Long-term weight loss, particularly for patients with a higher BMI (BMI of 55 or more).
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Reduced chance of developing an ulcer.
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The intestinal bypass portion of the surgery is partially reversible for those experiencing significant malnutrition issues.
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Virtually eliminates dumping syndrome, since the pyloric valve remains intact.
Disadvantages/risks of biliopancreatic diversion with a duodenal switch (BPD/DS):