Biliopancreatic diversion with duodenal switch is one of the types of bariatric or weight loss surgeries performed to help patients who struggle with obesity. During the procedure, surgeons start by creating a tubular stomach pouch and removing the majority of the organ, which is a similar technique to sleeve gastrectomy. Next, the pouch is connected to the last part of the small intestine, which is called the distal, so that food don’t pass through part of the stomach and about three-fourths of the small intestine.
Gastric bypass, adjustable gastric banding, sleeve gastrectomy and biliopancreatric diversion with duodenal switch are the bariatric procedures conducted in the United States, but all of them have advantages and disadvantages. Therefore, prior to being approved and even after the approval process, the procedures are studied and evaluated to assess its safety and effectiveness. In the case of biliopancreation diversion with duodenal switch, the surgery is particularly indicated for super obese patients, the equivalent to a Body Mass Index (BMI) higher than 50.
Safety of Biliopancreatic Diversion With Duodenal Switch
Biliopancreatic diversion with duodenal switch is a safe surgery, but like any other surgery, there is always the risk of complications. According to the American Society for Metabolic and Bariatric Surgery (ASMBS), the surgery has higher complication rates and risk for mortality than adjustable gastric banding, sleeve gastrectomy, and gastric bypass. There are complications that can occur in any surgery like infections, but patients may also develop right after the surgery, gallstones or nutritional deficiency like anemia or osteoporisis. According to the study “Biliopancreatic Diversion: The Effectiveness of Duodenal Switch and Its Limitations,” mortality during the surgery or up to 30 days following it has decreased from 6.1% to 4.9% to 2.1% in 2003, 2008, and 2011, respectively.
“It is important to acknowledge that BPD/DS is the procedure of choice for the most extremely obese patients; therefore it can be assumed that surgical risk in this group is higher at baseline,” explain the authors, who add that one-year complications occur in 25.7% of the patients and include minor complications such as gastrointestinal side effects, flatulence, malodorous stools, and steatorrhea, as well as major complications, like gastrointestinal anastomotic leak, dumping syndrome, malnutrition, iron-deficiency, protein calorie malnutrition, hypocalcemia, and deficiency of fat soluble vitamins, vitamin B1, vitamin B12, and folate.
Biliopancreatic Diversion With Duodenal Switch Efficacy
Despite the potential for risks and complications, biliopancreatic diversion with duodenal switch can also have great results, particularly among super obese patients. The procedure works by both reducing the size of the stomach, which means patients will feel full faster and with smaller amounts of food after the surgery, while it also impacts guts hormones positively influencing hunger, satiety and blood sugar control. Regarding weight loss, it is more effective than any other type of bariatric surgery, resulting in 60 to 70% excess weight loss or greater, at 5-year follow up.
“Being overweight predisposes patients to multiple serious medical comorbidities including type two diabetes (T2DM), hypertension, dyslipidemia, and obstructive sleep apnea. Lifestyle modifications including diet and exercise produce modest weight reduction and bariatric surgery is the only evidence-based intervention with sustainable results. Biliopancreatic diversion (BPD) produces the most significant weight loss with amelioration of many obesity-related comorbidities compared to other bariatric surgeries,” as explained in the study. In addition to weight loss, it also reduces the absorption of fat by 70 percent or more, and it is the most effective type of bariatric surgery against diabetes.