Biliopancreatic Diversion with duodenal switch

BPD-DS surgery, a modification of BPD surgery, combines a sleeve gastrectomy (removal of part of the stomach) with a long intestinal bypass.

Gastric Bypass : Biliopancreatic Diversion with Duodenal Switch Surgery

In the sleeve gastrectomy part of the surgery, the outer margin of the stomach is removed, leaving a banana shaped stomach, ¼ of its original capacity, that remains connected to the duodenum. This creates the restrictive portion of the surgery.

The surgeon accomplishes this by dividing the first part of the duodenum between the stomach and bile duct and closing off the divided end.

Biliopancreatic Diversion Duodenal Switch Surgery The surgeon then divides the small intestine about half way down, connecting the lower portion to the open end of the duodenum. This segment is referred to as the digestive, or roux, limb.

The remaining end of the small intestine is reconnected 75-100 cm from the large intestine creating the “common channel” allowing for bile and pancreatic juices to flow and mix with the food at the distal end of the small intestine, instead of in the duodenum, thereby limiting absorption of nutrients and calories.

Advantages of Gastric Bypass BPD-DS Surgery includes

Quick and dramatic weight loss Excellent long term weight loss results Unrestricted diet Able to eat larger portions of food than “pouch” surgeries Pyloric valve is left intact essentially eliminating “Dumping Syndrome” Normal stomach function is maintained but in a smaller capacity Reduced incidence of stomach ulcers due to removal of most of the acid secreting cells in stomach Continued weight loss for 18-24 months post surgery Many patients maintain a weight loss of 75-80% of excess weight 10 years post-op Improved health problems associated with severe obesity (ie. Diabetes, high blood pressure, sleep apnea, etc.) Improved mobility and quality of life.

Disadvantages to BPD with duodenal switch surgery include:

Major surgery with serious risks Most complicated of currently available obesity surgeries Limited number of surgeons performing this procedure via laparoscopy Usually performed as open operation instead of Laparoscopically, with associated risks Risk of death 1:100 surgeries Longer recovery time, usually 6-8 weeks Potential for protein malnutrition Malnourishment and anemia may occur requiring life long vitamin and mineral supplementation Malabsorptions require life long supplementation of fat soluble vitamins (A, D, E, and K), B12, calcium, and iron.

Life long follow up with physician required

Risk of iron deficiency anemia and osteoporosis if supplements not taken Increased risk of gallstones due to rapid weight loss Requires gallbladder removal during surgery due to high risk of gallstones

Not possible to fully reverse due to partial removal of stomach

Dumping syndrome : nausea, reflux, diarrhea can occur after ingesting high sugar foods Increased stool frequency to 2-4/day Hospital stay of 3-5 days usually Foul flatulence and diarrhea if fatty foods eaten Risk of hair loss.

Risks & Complications

As with any surgery there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages. It is important that you are informed of these risks before the surgery takes place. Most patients do not have complications after Gastric Bypass BPD-DS surgery; however complications can occur and depend on the patient’s health status. Complications can be medical (general) or specific to Gastric Bypass BPD-DS.

Medical complications include those of the anaesthesia and your general well being. Almost any medical condition can occur so this list is not complete. Complications include :

Allergic reaction to medications Blood loss requiring transfusion with its low risk of disease transmission Heart attack, strokes, kidney failure, pneumonia, bladder infections Complications from anaesthesia Serious medical problems can lead to ongoing health concerns, prolonged hospitalization, or rarely death. (Less than 1% cases)

Specific complications for Gastric Bypass BPD-DS include :

DVT (blood clot in the deep leg veins) Damage to adjacent organs especially spleen, pancreas and bile duct Abdominal hernia Leakage of digestive contents can lead to serious infection (Peritonitis)

Leakage of digestive contents from the staple line can lead to serious infection Stricture (narrowing) of the opening between the stomach and small intestine Dumping Syndrome: Vomiting, reflux, and diarrhea caused by stomach contents moving too rapidly through the small intestine Abdominal hernias Gallstones Dehydration Bleeding ulcers of the stomach Intolerance to some foods