The Biliopancreatic Diversion -
Duodenal Switch (BPD-DS)
The biliopancreatic diversion with duodenal
switch goes by many names. Some refer to it by the initials
BPD-DS. Many call it the "duodenal switch"
or just "the switch" for short. The National
Institutes of Health refers to the procedure as an "extensive
gastric bypass with duodenal switch." While less
commonly performed than the gastric bypass, this operation
has received a great deal of attention recently, particularly
on the internet, because it provides excellent weight
loss while allowing you to eat larger portions than
a gastric bypass.
the BPD/DS, roughly one half of the stomach is permanently
removed. The stomach goes from the shape of a small
pineapple to the size and shape of a banana. The pylorus,
which is the valve at the outlet of the stomach, remains
intact. The stomach is then connected to the last 250
centimeters (8 feet) of small intestine. The remainder
of the small intestine is connected 100 centimeters
from the end of the small bowel, forming the common
channel, where food mixes with the digestive enzymes.
The BPD-DS is a substantially "bigger"
operation than the gastric bypass. It is a bigger operation
for 2 reasons. First, it is the only bariatric operation
where a major portion of the stomach is permanently
removed -- this makes the procedure completely irreversible.
Second, a large section of small intestine is bypassed,
resulting in substantial malabsorption. This means that
the risks of long-term nutritional deficits are greater.
Why would someone want to have a larger
operation? The BPD-DS has 2 major advantages:
- The pylorus remains intact: this usually keeps
dumping syndrome from occurring after surgery (although
you may have different dietary restrictions)
- Since the stomach pouch is larger than with other
bariatric operations, you can eat larger portions
than with the gastric bypass or LAP-BAND®.
It is necessary to take a number of nutritional
supplements after the operation than after gastric bypass.
- Multivitamins (usually twice per day)
- Iron supplements (usually twice per day)
- Calcium (usually twice per day)
- ADEKs (fat-soluble vitamins) usually 3 times per
Additionally, there are some very significant
side effects that accompany this procedure, including:
- Frequent soft bowel movements (up to 4-6 per day)
- Frequent passing of foul-smelling gas
- Change in body odor
- Gas pains and bloating
- Hair loss
- Intolerance of certain foods (varies from person
Deciding on the BPD-DS
The decision about which operation is best for
you is a complicated one. Although the information presented
here may be helpful, you will be able to learn substantially
more about the benefits and risks of the BPD-DS operation
during you consultation with the bariatric team at Mount
Sinai. To arrange an appointment, click
Q. Is it true that
the weight loss with BPD-DS is better than any
other bariatric operation?
A. Typically, patients lose about 60-80%
of their excess body weight after BPD-DS. This
compares to 50-75% for the gastric bypass and
40-60% for the LAP-BAND®.