Biliopancreatic Diversion with Duodenal Switch
This procedure is performed in two components. First, the surgeon creates a smaller, tubular stomach pouch by removing a part of the stomach, as done in a sleeve gastrectomy surgery. In the next part, the small intestine is rerouted by bypassing a large portion of it.
During the procedure, the first portion of the small intestine, called the duodenum, is divided starting just from the outlet of the stomach. After this, a segment of the last portion or distal part of small intestine is brought up and attached to the outlet of the small stomach pouch. This will create a bypass, so that when the patient costumes the food, it goes to the newly created tubular pouch of stomach and then directly go into the last segment of the small intestine. Almost three-quarter of the small intestine is rerouted or bypassed by the food.
With this procedure a person can achieve greater weight loss than gastric bypass, sleeve gastrectomy or gastric band, i.e. around 60 – 70% percent loss of excess weight or more.
The bypassed part of the small intestine carries the enzymes from bile and pancreas, and these are necessary for the breakdown and absorption of protein and fat. This part is reconnected to the last part of the small intestine so that they can mix with food and digest it properly. Similar to the other bariatric surgeries, the Biliopancreatic Diversion with Duodenal Switch (BPD/DS) procedure also helps to reduce the amount of food consumed at a time. This effect starts to decrease over a period of time and patients can eventually consume almost normal quantity of food. But unlike the other surgeries, this procedure involves bypassing a significant amount of small bowel by the food.
Also, the food will not be mixed with the bile and pancreatic enzymes until it has reached very far down in the small intestine. This causes a decrease in the absorption of calories and nutrients, especially protein and fat. Additionally, the nutrients and vitamins which are dependent on fat for absorption, i.e. fat soluble vitamins and nutrients are also not properly absorbed. The procedure is similar to the gastric bypass and sleeve gastrectomy in terms that it affects gut hormones which control hunger and satiety as well as blood sugar control. Therefore, BPD/DS is known as the most effective procedure for the treatment of diabetes, an obesity related co-morbidity.