Biliopancreatic Diversion with Duodenal Switch
Like other bariatric procedures, a biliopancreatic diversion (BPD) is a surgical operation performed to promote weight loss in obese, usually morbidly obese, patients. It works by structurally shrinking the size of stomach and by keeping food to be digested out of most of the small intestine.
The small intestine is where most calories are absorbed, so preventing the food from entering the region results in a reduction of weight through a process called malabsorption. BPD has a fine track record of reversing obesity-related illnesses, such as diabetes. There are two ways of performing a BPD, with or without a duodenal switch.
Advantages of a BPD with Duodenal Switch
Prior to the introduction of the duodenal switch in 1999, BPD, though efficient in promoting weight loss, was problematic. The extreme efficiency in preventing absorption through bypassing the duodenum and jejunum of the small intestine resulted in the loss of a significant number of vital nutrients. The BPD with duodenal switch is now considered, in most cases, an improvement in surgical technique. Because the BPD with duodenal switch involves less stomach resection, it results in a lower risk of complications.
Less Risk of Gastric Dumping Syndrome
In the BPD with duodenal switch procedure, after a part of the stomach is removed, the remaining portion is attached to the duodenum or upper part of the small intestine. This is considered to be a safer and more effective procedure than the BPD done without the switch, since it leaves the pyloric valve intact and lessens the possibility of a complication called gastric dumping syndrome. Gastric dumping syndrome is a very unpleasant condition in which the patient suffers dizziness, fatigue, sweating, nausea, vomiting, and diarrhea within a given period, one-half to three hours, after eating.
Possibility of Reversing the Procedure
Although this procedure is much safer than BPD without a duodenal switch, there is still some risk of malnutrition or vitamin deficiency after this surgery. therefore, the patient must be vigilant about diet and supplementation after the procedure is performed. A major advantage of the BPD with duodenal switch is that the procedure may be reversed if the patient becomes malnourished.
Candidates for a BPD with Duodenal Switch
For obese patients who are unable to lose weight through diet, exercise or medication, a BPD may be a desirable option. Candidates for bariatric surgery, however, must be motivated to make permanent lifestyle changes since the surgery alone does not guarantee permanent weight loss. It is possible for patients who do not follow directives about diet and exercise to regain weight after the procedure. In the screening of those patients for whom bariatric surgery is appropriate, physicians investigate the following:
- History of inability to lose weight
- BMI of 40 or higher, indicating morbid obesity
- BMI of 35 to 39.9, indicating obesity, with a serious weight-related medical problem
- Slightly lower BMI with an extremely serious weight-related medical condition
- Medical conditions which might be exacerbated by the procedure, such as kidney stones
- Underlying psychological issues, such as eating disorders or depression
- History of substance abuse
Patient compliance is extremely important in any bariatric surgery. The patient must be prepared to have ongoing psychotherapy after surgery to treat issues around readjustment and cooperation with planned lifestyle changes.
The BPD with Duodenal Switch Procedure
During the BPD with duodenal switch procedure, a larger portion of the stomach is left intact than in other bariatric procedures. The duodenum, which attaches the stomach to the small intestine, is divided, as is the small intestine itself. The portion of the small intestine normally connected to the large intestine is instead attached to the short duodenal segment next to the stomach. The remaining section of the duodenum is connected to the pancreas and gallbladder, closer to the large intestine.
Because a good portion of the small intestine is circumvented, many fewer calories are absorbed by the body and weight loss results. Unlike some other bariatric surgeries, the BPD with duodenal switch leaves the pylorus, the valve controlling the rate at which food drains from the stomach, intact.
The first part of the BPD with duodenal switch procedure, during which the stomach is made smaller, is a sleeve gastrectomy, also called a vertical sleeve gastrectomy. Sometimes the sleeve gastrectomy is all that's needed to assist a patient in losing weight and the second part of the surgery, the BPD, is unnecessary.
Risks of a BPD with Duodenal Switch
A patient who has undergone BPD with duodenal switch is at a higher than usual risk of developing gallstones. For this reason, many surgeons remove the gallbladder while they are performing this surgery. Patients who have BPD with duodenal switch may also be in danger of :
- Malnutrition because of malabsorption of nutrients
- Leakage in the stomach or intestines
- Dumping syndrome, which causes vomiting and diarrhea
In order to avert whatever risk of malnutrition remains, even with the improved procedure, the patient will be advised to continue taking vitamin and mineral supplements once the surgery is over.
In addition to the particular risks of this procedure, the usual risks after any surgical procedure also apply. These may include:
- Excessive bleeding
- Blood clots
- Adverse reactions to anesthesia or medications
- Post-surgical infection
- Damage to adjacent organs
- Breathing problems
- Hernia at the incision site
While there are risks to the BPD surgery, whether performed with or without the duodenal switch, the benefits outweigh the risks in most cases. The mortality risk from this procedure is lower than that of most common operations, and the morbidly obese patient is usually far more endangered by the risks of obesity-related illnesses than by the surgery.
Recovery after a BPD with Duodenal Switch
Depending on whether the surgery is performed laparoscopically or through traditional open surgery, hospitalization and recovery time may vary. During the first week or so, pain medication will be prescribed. After a few weeks, the patient should be able to resume normal activities, apart from heavy lifting or carrying.
It is important for the patient to follow guidelines regarding diet, vitamin and mineral supplementation and exercise. It is also important for the patient to learn to eat slowly to avoid discomfort and possible vomiting or diarrhea since the capacity for food intake has been greatly decreased.
With changes to implement a healthy lifestyle, most patients do well after surgery, losing as much as 80 percent of their body weight if they started out as morbidly obese. Although some weight, perhaps 20 percent, may be regained in the future, patients who adhere to the stipulations given are able to lead longer and much healthier lives after the surgery than before. Weight-related complications, such as hypertension and type 2 diabetes usually improve or even disappear after surgery.