Biliopancreatic Diversion with Duodenal Switch (BPD/DS) Gastric Bypass
INTRODUCTION
The Biliopancreatic Diversion with Duodenal Switch – abbreviated as BPD/DS – is a procedure with two parts. First, a smaller, tubular stomach pouch is created by removing a portion of the stomach, very similar to the sleeve gastrectomy. Next, a large portion of the small intestine is bypassed (75%). The duodenum, or the first portion of the small intestine, is divided just past the outlet of the stomach. 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 the new 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 that are necessary for the breakdown and absorption of protein and fat, is reconnected to the last portion of the small intestine so that they can eventually mix with the food stream. Similar to the other surgeries described, the BPD/DS works by restriction and significant malabsorption (75% of intestine is bypassed). There is a significant amount of small bowel that does not see food anymore.
Because 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) as well as nutrients and vitamins dependent on fat for absorption (fat soluble vitamins and nutrients). The BPD/DS, similar to the gastric bypass and sleeve gastrectomy, affects guts hormones in a manner that impacts hunger and satiety as well as blood sugar control. Patients must take vitamins and mineral supplements after surgery. Even more than gastric bypass and sleeve gastrectomy patients. The BPD-DS is considered to be the most effective approved metabolic operation for the treatment of type 2 diabetes.
Am I a BPD/DS candidate
To be a candidate for any type of weight loss surgery, the individual must be severely (BMI > 35) or morbidly (BMI > 40) obese. If diabetes is present and it is not well controlled patients can qualify with a BMI > 30. Morbid obesity is usually defined as being about 100 pounds over your ideal body weight. A better way of defining morbid obesity is by using the Body Mass Index (BMI). BMI is a calculated number that takes weight and height into consideration. A person weighing 300 pounds who is 5ft tall will have a higher BMI than a person weighing 300 pounds but is 6 ft tall.
To determine if you qualify for the Duodenal switch, you can start by entering your weight and height into a BMI calculator.
Insurance companies often will have additional criteria to qualify for weight loss surgery. Our office can help you determine what those are. Below you will find the basic criteria most insurance companies use to determine if patients qualify for weight loss surgery:
BMI ≥ 40 regardless of medical problems
BMI ≥ 35 usually with medical problems such as:
- type II diabetes (T2DM),
- hypertension,
- sleep apnea and other respiratory disorders,
- non-alcoholic fatty liver disease,
- osteoarthritis,
- lipid abnormalities,
- gastrointestinal disorders, or
- heart disease.
BMI > 30 If Diabetes type II is not well controlled. Unfortunately most insurance companies are not yet covering for this criteria
Advantages
- Results in greatest weight loss 60 to 70% percent excess weight loss or greater, at 5 year follow up
- Reduces the absorption of fat by 70 percent or more
- 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 treatment of type 2 diabetes
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Disadvantages
- Has slightly higher complication rates than other procedures
- Highest malabsorption and greater possibility of vitamins and micro-nutrient deficiencies
- Reflux and heart burn can develop or get worse
- Risk of looser and more frequent bowel movements
- More complex surgery requiring more operative time
Deciding on the BPD/DS
The decision about which operation is best for you is a complicated one. The decision to proceed is based on the premise that the treatment should be less harmful than the disease being treated. Please read the obesity disease section of our website to learn about the disease, and the benefits weight loss surgery can offer to morbidly obese patients. Although the information presented throughout our website may be helpful, you will be able to learn substantially more about the benefits and risks of the BPD/DS operation during your consultation with our bariatric surgeons.
