Biliopancreatic Diversion with Duodenal Switch (BPD/DS)

The Biliopancreatic Diversion with Duodenal Switch (BPD/DS) is a type of surgical weight-loss procedure that combines elements of both restrictive and malabsorptive techniques. It is typically performed on individuals who are severely obese and have been unable to achieve significant weight loss through other means.

Procedure Overview

The BPD/DS procedure involves two main components:

• Duodenal Switch: The duodenum, the first portion of the small intestine, is surgically rerouted to connect to the final portion of the small intestine. This reduces the absorption of nutrients from food.
• Biliopancreatic Diversion: The gallbladder and a portion of the small intestine are bypassed, reducing the absorption of bile and pancreatic enzymes that aid in fat digestion.

Surgical Technique

The BPD/DS procedure is typically performed using a laparoscopic approach, which involves making several small incisions in the abdomen. The surgeon then uses specialized instruments to perform the following steps:

• Divide the stomach and create a smaller pouch.
• Reroute the duodenum to connect to the final portion of the small intestine.
• Bypass the gallbladder and a portion of the small intestine.

Benefits and Risks

The BPD/DS procedure can offer several benefits, including:

• Significant weight loss: Patients can expect to lose 60-80% of their excess body weight within the first year after surgery.
• Improvement in obesity-related health conditions: Such as type 2 diabetes, high blood pressure, and sleep apnea.

However, the BPD/DS procedure also carries several risks, including:

• Nutritional deficiencies: Patients may experience deficiencies in vitamins and minerals, such as vitamin D, calcium, and iron.
• Malabsorption: The reduced absorption of nutrients can lead to diarrhea, abdominal pain, and other gastrointestinal symptoms.
• Surgical complications: Such as infection, bleeding, and bowel obstruction.

Post-Operative Care and Follow-Up

After the BPD/DS procedure, patients typically require:

• Lifelong vitamin and mineral supplements to prevent nutritional deficiencies.
• Regular follow-up appointments with their surgeon and a registered dietitian to monitor their progress and address any concerns.
• A commitment to healthy eating habits and regular exercise to maintain weight loss and overall health.

Candidate Selection

The BPD/DS procedure is typically recommended for individuals who:

• Have a body mass index (BMI) of 40 or higher, or a BMI of 35-39 with at least one obesity-related health condition.
• Have been unable to achieve significant weight loss through other means, such as diet and exercise.
• Are willing and able to commit to lifelong follow-up care and lifestyle changes.