Biliopancreatic Diversion / Duodenal Switch
Our group has extensive experience in performing laparoscopic biliopancreatic diversion/duodenal switch operations. The biliopancreatic diversion/duodenal switch is the most effective operation for long term weight loss and has the lowest relapse rate. It does have the highest risk of vitamin deficiency. The Northern Westchester Hospital bariatric team has been instrumental in popularizing a new version of the switch that adds more restriction and reduces the number of daily bowel movements and malabsorption. Our group serves as teachers of this procedure and has several published videos that have been presented and made available through the American College of Surgery.
The biliopancreatic diversion/duodenal switch procedure combines a Sleeve Gastrectomy, with an intestinal bypass with a Roux limb of 150 cm, common channel of 125 to 150 cm and the remainder bypassed from the food circuit. Compared to a Gastric Bypass, a BPD-DS re-routes the intestines to a greater degree.
Although the Biliopancreatic Diversion/Duodenal Switch operation involves removing part of the stomach, the pyloric valve is preserved. This regulates the passage of stomach contents into the small intestines. By preserving the pylorus, there is a valve at the end of the stomach that controls emptying, making you feel full longer.
Stomach intestinal pylorus-sparing surgery, or SIPS Surgery is a modified biliopancreatic diversion/duodenal switch. It involves the formation of a sleeve gastrectomy that is slightly larger than our usual sleeve, with an attachment placed beneath the pyloric valve, which controls emptying of the stomach into the mid gut, located three meters from the terminal ileum.
Weight loss results from BPD/DS are excellent, with patients losing up to 82 percent of their excess weight as far out as 12 years. Initial weight loss occurs because patients eat less, and long-term weight loss occurs because fat and carbohydrates are not completely absorbed (malabsorption), but sugars are. This procedure provides the most malabsorption of the weight loss procedures.
A recent study showed that biliopancreatic diversion/duodenal switch patients that had a BMI greater than 50, lost significantly more weight than matched gastric bypass patients. At one year, those with a BMI of 55 reached a BMI of 32 with the biliopancreatic diversion/duodenal switch, compared to BMI of 38 with bypass. What is additionally important is that Switch patients lose weight between the first and third year, whereas bypass patients on average regain some weight.
This data has made more surgeons interested in the biliopancreatic diversion/duodenal switch, yet few have the expertise to offer this procedure laparoscopically. That is why Dr. Mitchell Roslin’s team is brought in to teach and proctor established surgeons all over the country such new procedures.
This is an operation that was popularized in Italy and later modified by surgeons in the US and Canada. With our switch, most patients move their bowels between one and three times per day. Compared to old versions, patients do not complain of uncontrolled BM’s and soiling. Blood work needs to be followed several times during the first year, and regularly after that. Patients must be compliant with their supplements, or they will develop issues after the operation.
Benefits of BPD/DS
- Biliopancreatic diversion/duodenal switch procedure offers maximal weight loss which can be maintained long-term.
- Dumping Syndrome does NOT occur. Dumping is a physical reaction in which food is “dumped” from the stomach into the intestines too quickly, before it has been properly digested.
- Leaks and infection can occur from where the intestines are re-routed, or from where part of the stomach is removed.
- A narrowing can occur where the duodenum is connected to the intestine.
- A wound infection can occur in the incision, which may require further therapy.
- Pancreatitis or inflammation of the pancreas can occur, which can be severe.
- Protein malnutrition occurs 3 to 10 percent of the time, which may require hospitalization.
- Vitamin, calcium and iron deficiencies can also occur.
This procedure is not reversible.
For more information on biliopancreatic diversion/duodenal switch and other bariatric surgeries performed at NWH, sign up for a seminar or call us at 877.677.1077.