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Biliopancreatic Diversion With Duodenal
Obese people who failed to lose weight by methods like diet, exercise, or medications can opt for bariatric surgeries. There are different types of bariatric surgeries, and biliopancreatic diversion with duodenal switch is one of the types. This type of bariatric surgery aids in losing more weight as compared to other bariatric procedures like sleeve gastrectomy or gastric bypass. However, it is a less common procedure due to its associated complications.
Before undergoing the procedure, it is important to understand the process and its associated benefits and complications.Switch (BPD/DS) What is Biliopancreatic Diversion With A Duodenal Switch (BPD/DS)?
BPD/DS, also known as duodenal switch, is a complex type of weight loss surgery in which the size of the stomach and length of the small intestine are altered.
The surgery includes two procedures, which can be done at one go or the second procedure is performed after the weight loss has begun. In the first procedure, a small tubular stomach pouch is made by removing most of the stomach portion, similar to sleeve gastrectomy procedure. Later, a major portion of the small intestine is bypassed. Thus, the food eaten passes through the newly created tubular stomach pouch and directly enters the last segment of the small intestine.
BPD/DS, like other bariatric surgeries help in losing weight by reducing the amount of food consumed, decreasing the absorption of calories as well as nutrients, and by influencing the gut hormones that affect satiety, hunger, and blood sugar control. Hence, this surgery is effective in treating diabetes, among other comorbidities.
The surgery includes two procedures, which can be done at one go or the second procedure is performed after the weight loss has begun. In the first procedure, a small tubular stomach pouch is made by removing most of the stomach portion, similar to sleeve gastrectomy procedure. Later, a major portion of the small intestine is bypassed. Thus, the food eaten passes through the newly created tubular stomach pouch and directly enters the last segment of the small intestine.
BPD/DS, like other bariatric surgeries help in losing weight by reducing the amount of food consumed, decreasing the absorption of calories as well as nutrients, and by influencing the gut hormones that affect satiety, hunger, and blood sugar control. Hence, this surgery is effective in treating diabetes, among other comorbidities.
Who are Eligible for BPD-DS?
BPD/DS is recommended for severely obese people who have related serious illnesses, such as type 2 diabetes, heart diseases, and high blood pressure. It is usually recommended for people with a BMI of 50 or more. It is can also be recommended for people with BMI of 40 or more with other serious health problems like:
- High cholesterol
- Heart disease
- Lung disease
- Sleep apnea
- Non-alcoholic fatty liver disease
- High blood pressure
How to Prepare for the Procedure?
Before the procedure, the person must undergo a physical examination to evaluate his/her health status. Several tests including a blood test, electrocardiogram, and chest x-ray are performed to assess the general health of the patient. The patient’s medical history including the list of all medicines, dietary or herbal supplements is sought for. If the list includes blood-thinning medications, the doses may be altered or discontinued temporarily, as these medicines affect the bleeding and clotting process. The dose of diabetes medications may also need to be altered. The patient may be required to begin a physical activity program. He/she will be asked to stop using tobacco products.
How is the Procedure Performed?
The surgery can be performed in two ways: open surgery or laparoscopic surgery. In traditional surgery, a single cut is made in the abdominal region. In the laparoscopic surgery, several small cuts are made in the abdominal region. The instruments are passed through the cuts to perform the procedure. The laparoscopic approach is preferred over the open surgery, as it carries lesser risk and results in faster recovery.
The surgery is performed under general anaesthesia.
Firstly, a large portion of the stomach is removed leaving a small narrow tube-like pouch. Then, the small intestine is incised below the duodenum, till the lower end of the small intestine. The pyloric valve that releases food into the small intestine and the first portion of the small intestine (duodenum) are left intact.
Then the incised part of the lower small intestine is brought up to the other end of the newly created stomach pouch, below the duodenum and is attached. Hence, the large part of the small intestine is bypassed. The bypassed segment of the small intestine is reconnected to the last part of the small intestine below the newly made connection. After completing the procedure, the instruments are removed, and the incisions are closed.
The surgery is performed under general anaesthesia.
Firstly, a large portion of the stomach is removed leaving a small narrow tube-like pouch. Then, the small intestine is incised below the duodenum, till the lower end of the small intestine. The pyloric valve that releases food into the small intestine and the first portion of the small intestine (duodenum) are left intact.
Then the incised part of the lower small intestine is brought up to the other end of the newly created stomach pouch, below the duodenum and is attached. Hence, the large part of the small intestine is bypassed. The bypassed segment of the small intestine is reconnected to the last part of the small intestine below the newly made connection. After completing the procedure, the instruments are removed, and the incisions are closed.
What Happens After the Surgery?
After the procedure, the patient is kept under close observation for a few days. The stay in the hospital is longer for open surgery procedure as compared to the laparoscopic surgery procedure. Initially, the patient is kept on liquid diet, giving time for the intestine and stomach to heal. Gradually, pureed foods are started over a couple of weeks. After a few months, soft foods and then solid foods are started, as the body starts tolerating the food.
The patient is provided a proper, detailed diet plan, which should be strictly followed. Some mineral and vitamin supplements especially multivitamins, vitamin B12, and calcium may be given to prevent nutritional deficiency.
For several months after the surgery, the patient is encouraged to attend frequent medical check-ups to monitor their health.
During the first 3-6 months after the surgery, the patient may experience several changes in the body, such as:
Tiredness Dry skin Body aches Mood changes Feeling cold Hair loss and hair thinning
The patient is provided a proper, detailed diet plan, which should be strictly followed. Some mineral and vitamin supplements especially multivitamins, vitamin B12, and calcium may be given to prevent nutritional deficiency.
For several months after the surgery, the patient is encouraged to attend frequent medical check-ups to monitor their health.
During the first 3-6 months after the surgery, the patient may experience several changes in the body, such as:
Tiredness Dry skin Body aches Mood changes Feeling cold Hair loss and hair thinning
What are the advantages of the surgery?
The advantages of BPD/DS are:
What are the risks associated with the BPD/DS?
- Aids in greater weight loss as compared to other bariatric surgeries (60-70%)
- Reduces fat absorption by 70%
- Allows the patient to eat a normal diet
- Leads to changes in the gut hormone that suppresses appetite
- Treats weight-related conditions effectively
What are the risks associated with the BPD/DS?
Like all other surgeries, BPD/DS also has some risks like:
- Infections
- Esophagitis and acid reflux
- Dumping syndrome causing cramping and diarrhoea
- Blood clots in legs that can lead to pulmonary embolism
- Hernia at the infection site
- Kidney failure
- Spleen injury
- Vomiting
- Reactions to anaesthesia
- Bowel obstructions
- Protein
- Calcium
- Iron
- Fat-soluble vitamins like A, E, D and K
- Thiamine
- Osteoporosis (bone thinning)
- Anaemia (lack of red blood cells)
- Kwashiorkor (life-threatening protein malnutrition)
- Kidney stones
Outlook
BPD/DS surgery helps in weight loss and aids in managing weight-loss related medical conditions, such as type 2 diabetes, high blood pressure, and heart disease. The patients may need to change their dietary habits for life. The risks and benefits of the procedure may differ for every individual depending upon the health status and age. Therefore, it is important to fully understand the benefits and risks for themselves. The success of the surgery completely depends on how well the person is accepting and following the recommended lifestyle changes.
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