Weight loss or bariatric surgery is usually the last option for patients who struggle to do it with other methods. Biliopancreatric diversion with duodenal switch is among most common bariatric surgeries available in the United States, alongside gastric bypass, adjustable gastric banding, and sleeve gastrectomy. In the case of biliopancreatic diversion with duodenal switch, it is particularly recommended for super obese patients, which means having a Body Mass Index (BMI) higher than 50, and who often suffer from associated diseases, such as high blood pressure, heart disease, diabetes, metabolic disease or sleep apnea.

However, treatment using biliopancreatic diversion with duodenal switch does not start or end with the surgery, which is why patients should be aware of the requirements of the entire journey. The procedure alters the normal digestive process, making the stomach smaller and redirecting the course of the food. During a biliopancreatic diversion with duodenal switch, surgeons cut a determined part of the stomach, so that the pylorus valve, which is responsible for food drainage from the stomach, intact. The new pouch created is then attached to the lower part of the small instestine, causing malnutrition of nutrients and calories.

Prior to the Biliopancreatic Diversion With Duodenal Switch Surgery

Even before deciding on a biliopancreatic diversion with duodenal switch, there are numerous factors to be considered by both physicians and patients. Physicians are expected to provide information on the risks of the surgery, possible results, commitment needed before and after the surgery, as well as an evaluation of patients’ overall health, need for a bariatric surgery, and eligibility criteria. To undergo a biliopancreatric diversion with duodenal switch, patients need to present copies of their medical record with the results of the evaluation, medical clearance from the primary care physician, and psychological clearance.

In addition to the physical evaluation, patients are also psychologically evaluated, since obesity may be related to underlying problems like stress or binge eating, in which cases surgery may not be the best option. Commitment and compliance to the physicians’ recommendations on an healthy diet and regular physical activity is crucial to assure weight loss. Patients need to follow a treatment plan, including lifestyle alterations that need to start even before the biliopancreatic procedure and has impact in the long-term.

Adopting new habits before the surgery may facilitate changes and increase weight loss after the surgery, while there are insurance companies that require patients to start losing weight before the biliopancreatic diversion to provide financial coverage. The healthcare team creates a personalized plan, considering the patient’s age, weight, and the existence of any co-morbidity, and provide specific guidelines on behavioral alterations during the preparation for the surgery, which can take months or even more than a year. Since patients who undergo a biliopancreatic diversion with duodenal switch are usually super obese, in some cases a sleeve gastrectomy is performed weeks before the final surgery.

Biliopancreatic Diversion With Duodenal Switch Surgical Procedure

If the patient is fully aware of the implications of undergoing a biliopancreatic diversion with duodenal switch, after being cleared by the medical team and having completed the preparation plan defined by the physicians, it is time to schedule the procedure. Patients will undergo additional lab tests and exams before the surgery, in addition to the dietary restrictions, and are requested to quit smoking. Work and house arrangements should be made before the biliopancreatic diversion with duodenal switch, and the night before, patients cannot eat or drink anything, since an empty stomach minimizes surgery risks. Asking a friend or family member to be there in the day may also reduce the stress and improve comfort.

Biliopancreatic diversion surgery is designed to alter the normal digestive system through the shrinking of the stomach. Surgeons reduce the size of the organ and create a bypass for the food to not pass the first part of the small intestine, which results in an increase of satiety and malabsorption of calories. There are two different types of biliopancreatic diversion. In the more simple procedure, part of the stomach is removed, while the remaining part is attached to the lower portion of the small intestine. The most common surgery is, however, the biliopancreatic diversion with duodenal switch, during which the surgeon removes a different part of the stomach, leaving the valve that controls food drainage from the stomach, the pylorus, intact.

Both surgical procedures can be performed either as open surgery, which is more invasive and has higher risks, or laparoscopically, which means that the surgeon makes small incisions in the abdomen to insert the surgical instruments and a small camera called a laparoscope. With advancements of technology, it is currently more common to undergo a laparoscopic biliopancreatic diversion, since it is less invasive and has lower risks. The surgery won’t provoke weight loss alone and patients need to commit to a healthier lifestyle, but it is expected to make patients feel full faster and with smaller amounts of food.

Following the Biliopancreatic Diversion With Duodenal Switch

After the biliopancreatic diversion with duodenal switch, patients will wake up from the general anesthesia and may not feel any pain due to the medication. However, being submitted to any type of bariatric surgery is aggressive for the body and it needs time to heal. Following the procedure, patients usually need to stay in the hospital for two or three days, during which the physicians evaluate if the new digestive system works properly and if there are no staple leaks. It is normal to start experiencing abdominal pain, and after going home, patients will have to wait at least two weeks before going back to work and will start on a special diet meant to help the stomach heal.

Right after the surgery, the stomach can only hold small amounts of soft food and liquids. During the first months patients will carefully transition to solid foods, according to the doctor’s recommendations. Starting about four weeks after the surgery, patients are advised to start regular follow-up visits, and individual counseling or support groups. According to the American Society for Metabolic and Bariatric Surgery (ASMBS), the biliopancreatic diversion with dueodenal switch is the type of bariatric surgery able to cause best results, with 60 to 70% of excess weight loss or greater, at 5 year follow up.

In addition, there are also other advantages. Patients are able to eventually eat meals almost normally, while it reduces the absorption of fat by 70 percent or more, it causes favorable changes in gut hormones to reduce appetite and improve satiety and it is the most effective against diabetes. However, there are also disadvantages, and the biliopancreatic diversion with duodenal switch has higher complication rates and risk for mortality than any other procedure. The procedure has a greater potential to cause protein deficiencies and long-term deficiencies in a number of vitamin and minerals, such as iron, calcium, zinc, fat-soluble vitamins such as vitamin D.

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