Biliopancreatic Diversion with Duodenal Switch
The Biliopancreatic Diversion with Duodenal Switch—abbreviated as BPD/DS—is a procedure with two components. First, a portion of the stomach is removed to create a smaller, tubular stomach pouch, similar to the sleeve gastrectomy. Next, a large portion of the small intestine is bypassed.
The Procedure
The duodenum, or the first portion of the small intestine, is divided just past the stomach outlet. A segment of the distal (last portion) small intestine is then brought up and connected to the outlet of the newly created stomach so that when the patient eats, the food goes through a newly created tubular stomach pouch and empties directly into the last segment of the small intestine. Roughly three-fourths of the small intestine is bypassed by the food stream.
The bypassed small intestine, which carries the bile and pancreatic enzymes necessary for the breakdown and absorption of protein and fat, is reconnected to the last portion of the small intestine to mix with the food stream eventually. Like the other surgeries described above, the BPD/DS initially helps reduce the amount of food consumed; however, over time, this effect lessens, and patients can eventually consume near “normal” amounts of food. Unlike the other procedures, there is a significant amount of small bowel that is bypassed by the food stream.
The food also mixes with the bile and pancreatic enzymes very far down the small intestine. This results in a significant decrease in the absorption of calories and nutrients (particularly protein and fat) and nutrients and vitamins dependent on fat for absorption (fat-soluble vitamins and nutrients). Lastly, the BPD/DS, similar to the gastric bypass and sleeve gastrectomy, affects gut hormones in a manner that impacts hunger and satiety as well as blood sugar control. The BPD/DS is considered to be the most effective surgery for the treatment of diabetes among those that are described here.

Advantages
- Results in more significant weight loss than RYGB, LSG, or AGB, i.e. 60 – 70% percent excess weight loss or greater, at five year follow up
- Allows patients to eat near “normal” meals eventually
- Reduces the absorption of fat by 70 percent or more
- Causes favorable changes in gut hormones to reduce appetite and improve satiety
- Is the most effective against diabetes compared to RYGB, LSG, and AGB
Disadvantages
- It has higher complication rates and risk for mortality than the AGB, LSG, and RYGB
- Requires a more extended hospital stay than the AGB or LSG
- It has a greater potential to cause protein deficiencies and long-term deficiencies in a number of vitamins and minerals, i.e. iron, calcium, zinc, fat-soluble vitamins such as vitamin D
- 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
