Laparoscopic Biliary Pancreatic Diversion with Duodenal Switch

We are proud to be one of the fewest centers in the United States to offer the Biliary Pancreatic Diversion with Duodenal Switch (BPD with DS). This is a standard bariatric procedure that has been performed for over 30 years and has the highest associated excess weight loss of all approved operations. Patients can reasonably expect to achieve excess weight loss of approximately 80 to 85 percent, which allows patients with BMI over 50 to achieve a healthy weight.

This procedure reduces the size of the stomach by creating a sleeve and bypassing some of the intestines, which decreases the patient’s appetite. It is usually recommended for but not limited to patients whose initial BMI is over 50; patients with uncontrolled type 2 Diabetes; and as a revisional procedure for Sleeve Gastrectomy or Gastric Bypass patients who regained their weight back or could not achieve satisfactory weight loss.

BPD with DS advantages

  • It can produce the greatest excess weight loss because it provides the highest levels of malabsorption (70% or more of fat malabsorption).
  • On average excess weight loss has been reported in the literature to range from 70-85% at five years or more of follow-up. 
  • It is by far the best operation for Diabetes Mellitus especially for those with severe and difficult to control Type 2 Diabetes with recorded resolution rate of 98-99%.
  • Often results in a high degree of patient satisfaction because patients are eventually able to eat near “normal” meals than with a purely restrictive or standard Roux-en-Y gastric bypass procedure
  • It produces favorable changes in gut hormones to reduce appetite and improve satiety.
  • It can be used as a primary weight loss operation or as a revisional procedure due to inadequate weight loss or weight regain, after the Gastric Sleeve, Gastric Band or Gastric Bypass.
  • For all malabsorption procedures there is a period of intestinal adaptation when bowel movements can be very liquid and frequent. This condition may lessen over time, but may be a permanent lifelong occurrence.
  • Abdominal bloating and malodorous stool or gas may occur.
  • Has a greater potential to cause protein deficiencies and long-term deficiencies in a number of vitamin and minerals if patients are non-compliant with the nutritional guidelines. Close lifelong monitoring for protein malnutrition, anemia and bone disease is recommended.
  • Changes to the intestinal structure can result in the increased risk of gallstone formation and the need for removal of the gallbladder.
  • Accounts for less than 5 percent of currently performed bariatric surgery due to concerns of technical difficulty, malnutrient deficiency, and postoperative frequent bowel movements.
Recovery timeline
  • Most patients have a 2-3 day hospital stay.
  • The post-operative dietary phases and schedule are very similar to the Gastric Bypass and Gastric Sleeve with few adjustments.
  • Patients can return to office style work in 1-2 weeks and have unrestricted activity at 4-6 weeks.
  • Patients must be prepared to follow the prescribed diet or they may suffer from diarrhea and flatulence.
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March 25, 2020