Biliopancreatic Diversion with Duodenal Switch (BPD-DS)

Biliopancreatic diversion with duodenal switch, or BPD-DS, is technically a type of gastric bypass surgery, but it's less common than Roux-en-Y gastric bypass. The BPD-DS is for more obese patients. It's a two-surgery process with a partial gastrectomy followed by the BPD-DS procedure.

In the partial gastrectomy before BPD-DS, only about half of your stomach is removed, compared to about 85% of your stomach in a vertical sleeve gastrectomy. This surgery gives the patient a chance to lose some weight in the weeks before the second surgery.

In the second surgery, your small intestine is divided into two parts. One part, the alimentary limb, gets connected to the bottom of your stomach. The rest of your small intestine, now called the biliopancreatic limb, is attached to the bile duct. Food travels down the alimentary limb into your colon, without being absorbed in the biliopancreatic limb. Digestive juices are free to flow from your biliopancreatic limb to your alimentary limb. This means food is digested (broken down), but not absorbed (taken into your body).

Advantages and Disadvantages of the BPD-DS

Advantages of the BPD-DS

• Among the highest rates of weight loss in the first year
• Good long-term weight loss and maintenance
• Good choice for high-BMI patients

Disadvantages of the BPD-DS

• Likelihood of nutritional deficiencies, including protein, vitamins and minerals
• Certain variations of the procedure can cause diarrhea and dumping syndrome if diet is not followed
• Irreversible with few options for revisional surgery

Possible Complications/Risks with the BPD-DS

• Death: 1% risk of death related to surgery
• Chronic diarrhea and flatulence
• Nutrient deficiencies
• Post-surgery vomiting

Weight Loss and the BPD-DS

Restrictive: The BPD-DS reduces your stomach size by 50%. Its size after surgery is only four to five ounces, so it doesn't hold as much food as it did before surgery, when you had your entire stomach. You get full sooner and are less likely to eat too many calories.

Malabsorptive: Nutrient absorption decreases because food bypasses part of the small intestine and because your digestive juices are rerouted. Even though food is broken in your gastrointestinal tract, it's not completely absorbed into your body. Therefore, you get fewer calories and nutrients.