Atrium Health Navicent Weight Management

Biliopancreatic Diversion with Duodenal Switch (BPD/DS)

Biliopancreatic diversion seeks, by making the stomach smaller, to change the body's digestion process. It allows your body to absorb fewer calories by making it possible for food to bypass the small intestine and makes it so that the individual will feel fuller sooner than when the stomach was larger. The procedure is conducted by the use of laparoscopy wherein a camera is used to guide the surgery or is performed as an open procedure, where a large cut is made in the belly.

For the most part, due to the severe risk involved in the surgery, biliopancreatic diversion is reserved for the morbidly obese (individuals with a BMI, body mass index, greater than 50) and have exhausted every other form of weight loss. Before partaking in this procedure, a doctor will normally encourage a patient to engage in healthier activities and habits such as physical exercise and healthy eating.

In regards to the biliopancreatic diversion with duodenal switch surgery, most doctors will not perform the surgery except in exceptional cases of obesity and if weight is causing serious health concerns in the patient. In the procedure, a different part of the stomach is removed than in the normal biliopancreatic diversion surgery and the pylorus the valve controlling food draining from the stomach is left intact. This procedure is considered more high-risk than, the already potentially highly hazardous, traditional biliopancreatic diversion and most surgeons will avoid performing it if possible.

Both surgeries are highly risky procedures because both prevent the body from properly absorbing food nutrients likely causing lifelong health problems. In some cases, depending on the body of the patient, many of these problems can be properly handled by the ingestion of mineral supplements and vitamin pills. Otherwise, patients should consider that this surgery is not cosmetic in nature. It will not remove any actual fat from the body it merely changes the way that your body breaks down and absorbs food.

For others, however, there may be no possible way of treating the long-term health issues created by the surgery. It is important not to consider this surgery any sort of easy fix for weight problems. Any patient will still need to get regular exercise and eat in a healthy fashion.

Effectiveness:

In general, the surgery is highly effective especially for those who demonstrate a sincere desire to keep the weight off. Those who follow recommended eating plans, keep appointments with medical teams, and exercise regularly will keep the weight off indefinitely. However, those who don't accomplish those things will, on average, gain back anywhere from 20%-25% of the weight lost within ten years. Otherwise, the average patient will generally lose anywhere from between 75% to 80% of their unhealthy body fat.

After Surgery:

Once the procedure has been completed, a patient will likely experience a little belly and pain and may require the use of pain medication. This will, for the most part, be due to the large incision made in the belly. In addition, patients may notice that their bowel movements are irregular after surgery. There is not much that can be done about this other than the normal steps in avoiding constipation, as well as avoiding straining during bowel movements. Otherwise, right out of the surgery, a patient should notice that they feel full more quickly after eating a meal. If not, a patient should contact their doctor immediately.

Risks:

As already mentioned, the main concern with this surgery is the diminished ability of a patient's body to absorb nutrients. Many patients undergoing the biliopancreatic diversion with duodenal switch surgery experience a deficiency in calcium, iron, magnesium, and many other vitamins. A particular concern in women prone to depression is the inability to absorb Vitamin D which is a necessary vitamin for the proper function of hormone levels.

Some patients may experience what is called "dumping syndrome" within a day or two of the procedure which is a collection of symptoms that one experiences after many forms of gastric surgery and may include nausea, vomiting, abdominal cramping, diarrhea, sweating, light-headedness, and rapid heartbeat. In addition, energy levels may be diminished because the body is no longer able to absorb nutrients in the same way that it once could. Most patients should avoid any strenuous exercise or heavy lifting post-surgery.

In addition, a much higher risk of bone complication, like the development of osteoporosis, is associated with patients who have undergone the biliopancreatic diversion with duodenal switch surgery. This is primarily due, again, to the diminished ability of your body to absorb nutrients.

Food Ingestion Post-surgery

For the first month after surgery, most patients will not be able to handle anything other than liquids and soft foods. This is due to the healing process that will need to occur after the procedure. In addition, patients will be prone to dehydration and will need to take steps to make sure that they are getting the proper volume of liquids. A doctor will normally insist upon specific dietary and liquid consumption instructions, especially in the days and weeks immediately following the surgery.

Over time, the patient will be able to slowly include solid foods back into their diet regimen. But they will need to be wary about chewing their food carefully and to stop eating once they feel full. This can take some time to become an intuitive process, as the patient will feel fuller much quicker than they are normally used to. Overeating is the primary cause of nausea, diarrhea, and vomiting in patients after the procedure. Also, some patients will not lose weight if they are ingesting high volumes of soda or juices high in sugar content.

Conclusion:

Biliopancreatic Diversion with Duodenal Switch is a highly effective surgery and has benefited a large swath of the obese population. However, it should be emphasized, again, that there are serious risks associated with the procedure. A patient will not be able to absorb nutrients properly and will need to ingest vitamins and mineral supplements for the rest of their life. Otherwise, patients must not consider the surgery a "cure-all" for obesity. Patients will still need to attempt to live a healthy life eating properly and getting enough exercise.