Biliopancreatic Diversion with Duodenal Switch

Educational/promotional video provided by Ethicon, for the purpose of patient education.

The Washington University Weight Loss Surgery Program offers minimally invasive biliopancreatic diversion with duodenal switch (BPD/DS), a less common weight-loss procedure that is recommended for people with a body mass index (BMI) greater than 50 kg/m2.

The BPD/DS procedure has two components. First, a smaller stomach pouch is created by removing about 60-70% of the stomach and creating a slightly wider sleeve gastrectomy. Then the duodenum, the first part of the small intestine, is divided just past the outlet of the stomach. The surgeon also divides the last portion of the small intestine, and the remaining segment of the small intestine is brought up and connected to the outlet just below the new stomach. About three-fourths of the small intestine is bypassed by the food stream.

The bypassed small intestine carries bile and pancreatic enzymes needed for the breakdown and absorption of protein and fat, so the surgeon reconnects it to the last portion of the small intestine. This allows the bile and enzymes to mix with the food stream.

The BPD/DS is performed using a laparoscopic or robotic approach, reducing the high complication rate of the open surgery.

BPD/DS can result in greater weight loss than gastric bypass surgery (GB), laparoscopic sleeve gastrectomy (LSG) and adjustable laparoscopic banding (ALB). At five-year follow up, BPD/DS patients have an average weight loss of 60-70% or greater. The procedure reduces absorption of fat by 70% or more, and patients eventually eat near “normal” meals. Like other bariatric procedures, it reduces appetite and can change the taste of food. It is the most effective bariatric procedure against diabetes.

The BPD/DS procedure has higher complication rates and risk for mortality than the GB, LSG, and ALB. Other disadvantages are:

  • Requires a longer hospital stay than the other procedures
  • Has a greater potential to cause protein calorie malnutrition and long-term deficiencies in vitamins and minerals
  • Keeping follow-up visits, compliance with care guidelines, and STRICT adherence to dietary and vitamin supplementation guidelines are critical to avoid protein and certain vitamin deficiencies that can cause serious complications

Surgeons who perform this procedure:

Shaina Eckhouse, MD

For more information, call 314.454.7224.

Source: American Society for Metabolic and Bariatric Surgery