Biliopancreatic diversion with duodenal switch (BPD-DS) is a type of bariatric (weight loss) surgery. It is a minimally invasive surgical option for people with severe obesity. It is sometimes known as a duodenal switch surgery, gastric reduction duodenal switch, or classic switch procedure.
BPD-DS can lead to significant weight loss —more than other bariatric procedures like gastric sleeve and gastric bypass. It also can help reduce or resolve other weight-related medical problems like diabetes or high blood pressure.
As a high-volume surgery center, UPMC Bariatric Services has experienced surgeons and excellent outcomes.
Biliopancreatic diversion with duodenal switch (BPD-DS) surgery is a bariatric procedure. It combines a traditional gastric sleeve with elements of a gastric bypass.
In the first part of BPD-DS, the surgeon removes most of the stomach, leaving behind a portion about the size of a banana.
In the second part, they reroute the normal path of digestion by dividing the duodenum and reattaching it. These attachment points are called anastomoses. The duodenum is the first part of the small intestine, a tube connecting the stomach to the middle of the small intestine.
They cut the duodenum where it attaches to the stomach, but leave the lower part connected to the pancreas and liver, which make digestive juices.
They connect the upper part of the duodenum to the ileum, the lower part of the small intestine. This moves the start of digestion further down the intestinal tract.
They then connect the lower half of the duodenum to the end of the ileum (small intestine) lower than the previous anastomosis (attachment). This creates a Y configuration.
Because of these actions, BPD-DS is both:
BPD-DS can lead to significant weight loss (up to 40% of your total body weight). It also can help reduce or resolve other weight-related health problems.
However, BPD-DS comes with potential complications, including vitamin and protein insufficiency and gastrointestinal issues. It has become a less common bariatric procedure in recent years.
Back to top.Obesity, defined as having a body mass index (BMI) of 30 and higher, is a significant problem in the United States. Obesity is associated with many other health conditions and can lead to early death. The higher your BMI, the greater the risk.
For people with severe obesity (a BMI of 40 and higher), surgery is the best chance for significant weight loss.
BPD-DS can help people lose a lot of weight and may help improve other health conditions. These features can make it a good option for people with obesity, especially those with severe obesity.
Most people with obesity can be a candidate for BPD-DS. Because it can help create more significant weight loss than gastric sleeve or gastric bypass, it can especially help people with severe obesity. People with severe obesity and other health problems — diabetes, high blood pressure, high cholesterol, and more — are also candidates.
People with obesity and a current or past history of smoking are also candidates for BPD-DS. There is a lower risk of internal ulcers developing after BPD-DS compared to other bariatric procedures.
BPD-DS can also be a revisional procedure for people who have experienced complications with previous bariatric procedures.
However, people with severe acid reflux are not candidates for BPD-DS.
Alternatives to BPD-DS include:
BPD-DS can lead to greater weight loss than gastric bypass and gastric sleeve. People can lose up to 40% of their total body weight, compared to 30% with gastric bypass and 25% with gastric sleeve.
However, BPD-DS also can have more complications than other procedures.
Back to top.The biggest complication, or side effect, of BPD-DS is the potential for vitamin and protein deficiencies. The malabsorption effect of the procedure means that your body may not get enough key nutrients from what you eat. To combat this complication, you will have to take vitamin supplements and eat a higher-protein diet.
BPD-DS also carries risks similar to those of other bariatric procedures.
There is a very minor risk of dumping syndrome, a condition that occurs when large volumes of food move through the small intestine. Dumping syndrome typically happens when you consume food with high fat or sugar content.
It can cause symptoms like:
Other risks of BPD-DS surgery include:
These risks are rare. Your surgeon will review the risks and benefits of BPD-DS and other bariatric procedures with you.
Back to top.Before your surgery, you will meet with your surgeon and other UPMC Bariatric Services team members. Your team can include specialists like dietitians and psychiatrists. The goal is to prepare you for the lifestyle changes you'll need to make after surgery.
If you have other weight-related health problems, you may need to visit specialists for additional blood tests and screenings.
Your doctor may recommend that you lose a certain amount of weight before your procedure. They may prescribe medication to aid weight loss or put you on a specific diet.
You can continue to take most of your medication until the night before your procedure. If you take a medication that can cause complications with your procedure, you may need to stop taking it sooner.
Your doctor will review specific recommendations to help you prepare for your procedure.
The BPD-DS procedure typically lasts two to three hours.
During the procedure, you will be under general anesthesia. You also will receive pain-blocking medicine to help with the pain after the procedure.
Surgeons typically perform BPD-DS as a minimally invasive laparoscopic procedure. They may use robotic technology, which can improve their dexterity and vision.
The first part of BPD-DS begins with a typical gastric sleeve:
Next, the surgeon reroutes the small intestine to change the typical path of digestion.
Afterward, the surgeon checks the connection sites for leaks or other problems. Once finished, they close.
After surgery, you will spend a couple of hours in the recovery room. Then, they will move you to the inpatient surgical unit.
Patients typically spend one night in the hospital after BPD-DS.
After moving to the inpatient unit, your care team will get you up and walking. This can help lower the risk of blood clots developing after your procedure. For this reason, you may also be placed on blood thinners.
After BPD-DS, you'll follow a progressive diet.
It includes:
After about a month, you can resume your regular diet. You may notice changes in your appetite after the procedure.
After BPD-DS, your diet should include protein-rich foods to avoid protein deficiencies. You should avoid foods high in fat and sugar content, as well as fried foods. You should make sure to stay hydrated by drinking at least 64 ounces of water per day.
Take supplements containing vitamins A, B, D, E, and K to avoid vitamin and mineral deficiencies.
You may also meet with a dietitian after your procedure who can help you develop a healthy eating plan.
You can walk on the day of your procedure. As you recover, it's important to get up and walk as much as you can. Within about three weeks, you can start doing heavier exercises, such as lifting heavy weights. Your doctor will provide further guidance.
You may be on narcotic medication for a few days after your procedure. You should not drive while on narcotic medication.
If you're not on medication, you can drive within a few days of BPD-DS. Your doctor will give you specific recommendations.
People with desk jobs typically can return to work within about a week. If your job requires heavy lifting, you should wait three weeks before returning to work.
BPD-DS typically entails more follow-up visits than other bariatric procedures. These visits help ensure your recovery is going well and that you're not developing vitamin or protein deficiencies or other complications.
You can expect to have follow-up visits:
You may be seeing other members of your bariatric team, including a dietitian and psychiatrist. They can help you adapt to the lifestyle changes you need to make after surgery.
BPD-DS combined with lifestyle changes can lead to significant long-term weight loss. People can lose up to 40% of their total body weight after BPD-DS.
BPD-DS also can help reduce or resolve other weight-related health problems.
Back to top.UPMC Bariatric Services has the highest level of national accreditation from the American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). This designation means we meet high standards for safety, quality of care, and patient outcomes.
We are a high-volume surgical center. Our surgeons have years of experience in performing bariatric procedures with excellent outcomes.
In addition, UPMC Bariatric Services is a multidisciplinary team with specialists like dietitians and psychiatrists. Our team will work with you to help you meet your weight loss and health goals.
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