Biliopancreatic diversion with duodenal switch is one of several surgical procedures performed to help patients who struggle with obesity and have failed to lose weight with other non-surgical methods. There are other types of weight loss or bariatric surgery conducted in the United States, including gastric bypass, adjustable gastric banding and sleeve gastrectomy, but the biliopancreatic diversion with duodenal switch is particularly indicated for patients with super obesity, the equivalent to a Body Mass Index higher than 50.
During the procedure, surgeons start by reducing the size of the stomach by creating a small, tubular stomach pouch and removing the remaining part, in a process similar to sleeve gastrectomy, which results in an increase of satiety. After that, surgeons create a bypass that connects the newly-created pouch to the last portion of the small intestine, so that when the patient eats, the food goes through the pouch and empties directly into the last segment of the small intestine.
Biliopancreatic Diversion with Duodenal Switch Pros and Cons: Advantages
Biliopancreatic diversion with duodenal switch is a very effective procedure that makes food bypass the part of the small intestine that carries the bile and pancreatic enzymes necessary for the breakdown and absorption of protein and fat. Similarly to gastric bypass and sleeve gastrectomy, the surgery also impacts gut hormones responsible for hunger, satiety and blood sugar control. According to the American Society for Metabolic and Bariatric Surgery (ASMBS), biliopancreatic diversion reduces the absorption of fat by more than 70%.
Therefore, the surgery tends to have better results in weight loss than gastric bypass, sleeve gastrectomy or adjustable gastric banding, being the most effective procedure and provoking between 60 and 70% excess weight loss at five year follow up. In addition, it is also the most effective procedure in the treatment of diabetes, one common comorbidity resultant from obesity. Unlike other surgeries, patients submitted to biliopancreatic diversion with duodenal switch will most likely be able to return to normal meals after the stomach heals.
Biliopancreatic Diversion with Duodenal Switch Pros and Cons: Disadvantages
Despite the fact that biliopancreatic diversion with duodenal switch has great results regarding weight loss and disease management, the procedure is also the most aggressive one, having higher rates and risk for mortality than adjustable gastric banding, sleeve gastrectomy or gastric bypass. According to the ASMBS, while “it initially helps to reduce the amount of food that is consumed (…), over time this effect lessens and patients are able to eventually consume near “normal” amounts of food.”
In addition, patients who undergo a biliopancreatic diversion with duodenal switch need to stay in the hospital longer than patients who received a gastric band or sleeve gastrectomy. “Additionally, the food does not mix with the bile and pancreatic enzymes until very far down the small intestine. This results in a significant decrease in the absorption of calories and nutrients (particularly protein and fat) as well as nutrients and vitamins dependent on fat for absorption (fat soluble vitamins and nutrients).” Compliance with follow-up visits and care and strict adherence to dietary and vitamin supplementation guidelines are critical to avoiding serious complications from protein and certain vitamin deficiencies.