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.

In 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®.

Living with the BPD-DS
It is necessary to take a number of nutritional supplements after the operation than after gastric bypass. These include:

  • Multivitamins (usually twice per day)
  • Iron supplements (usually twice per day)
  • Calcium (usually twice per day)
  • ADEKs (fat-soluble vitamins) usually 3 times per day

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 to 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 here.


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®.

weight loss surgery bariatric bypass surgery obesity morbid bariatric surgery bariatric bypass surgery rny gastric bpd lap band laparoscopic bariatric weight loss surgery obesity obesity surgery weight loss bmi calculator body mass index insurance coverage weight loss surgery bypass band bpd gastric bypass rny roux-en-y stapling laparoscopic lap band lap-band gastric banding laparoscopic adjustable biliopancreatic diversion duodenal switch bpd sleeve gastrectomy operation morbid obesity bariatric revision revisional surgery repair laparoscopic surgery bariatric keyhole minimally invasive minimal incision access open surgery bariatric traditional incision weight loss surgery bariatric bariatric weight loss surgery bariatric weight loss surgery weight loss surgery appointment bariatric weight loss surgery surgeon preop preoperative consult consultation workup evaluation preop additional preoperative consult consultation workup evaluation insurance coverage approval weight loss bariatric surgery bariatric weight loss surgery operation after surgery weight loss lap laparoscopic bariatric bypass recovery hospital stay surgery weight loss bariatric lap laparoscopic bypass band weeks after stay surgery weight loss bariatric lap laparoscopic bypass band year after surgery weight loss bariatric lap laparoscopic bypass band pregnancy after surgery weight loss bariatric lap laparoscopic bypass band team approach weight loss surgery bariatric Daniel Herron MD bariatric surgery weight loss Subhash Kini MD surgeon bariatric weight loss surgery psychiatrist bariatric weight loss surgery psychologist bariatric weight loss surgery nurse practitioner preoperative bariatric weight loss surgery nutritionist dietitian dietician bariatric weight loss surgery medical assistant bariatric weight loss surgery patient support after bariatric surgery weight loss operation information session weight loss surgery bariatric support group gastric bypass rny roux surgery support group biliopancreatic diversion duodenal switch bpd surgery support group lap band lap-band adjustable gastric band surgery support group online gastric bypass rny roux bpd band surgery nutrition food guide bariatric surgery postoperative postop vitamins weight loss surgery nutrition help weight loss surgery bariatric bariatric surgery definitions glossary Mount Sinai Program Surgical Weight Loss Location