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The biliopancreatic diversion can be performed alone (BPD) or with duodenal switch (BPD/DS).
Other names include BPD/DS, DS, BPD, or Scopinaro procedure. All these procedures are malabsorptive
operations - they cause food to be poorly digested and absorbed. A smaller stomach pouch is made by
removing about 2/3 of the stomach. The remaining stomach is re-connected to the lower end of the
small intestine. Almost 9 feet of small intestine is bypassed. This means that food is digested
and absorbed in only 2-3 feet of intestine before it enters the large intestine.
The main differences between the BPD
and the BPD/DS ly in:
- which part of the stomach is actually removed. (BPD=lower part of the stomach
removed, BPD/DS= left side of the stomach removed)
- the presence or absence of the pylorus - a muscular valve that separates the stomach from the
duodenum. (BPD=pylorus removed,
BPD/DS=presence of the pylorus maintained, though the advantages of this remain unclear)
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Both of these operations have their own advantages
and disadvantages which can be further discussed with your surgeon, but essentially are equally
malabsorptive. The BPD and BPD/DS operations have been performed extensively in Europe and are performed
by a few surgeons in North America, only a hand-full of which use the laparoscopic technique.
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Advantages:
- Weight-loss ranges from 70%-90% of excess body weight in patients with a BMI 35-85 kg/m2,
over the first 2 years. This equals roughly 100-300 pounds, depending on your original weight.
After that, there is almost no weight-regain. It is one of the most powerful operations to achieve
a large amount of long-lasting weight-loss.
- The majority of existing co-morbidities are improved,
or even cured.
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Disadvantages:
- Since only 25% of fat is absorbed after this operation, most patients will
experience frequent, foul-smelling, pasty bowel movements, especially after
eating fatty food. Other associated side-effects include flatulence and bloating.
These side-effects typically improve after the first 6 months, and by avoiding fatty foods.
- Only part of the operation is reversible. The small intestine can be reconnected
to its original anatomy; however, the stomach pouch will remain smaller for several years.
- Since more food (especially fat) is not absorbed due to a length
of intestine being bypassed, there is a higher chance for nutritional problems.
For this reason, it will be necessary to take daily vitamin and mineral supplements
everyday for the rest of your life so that you avoid any problems with nutritional
deficiencies. The supplements include: a multivitamin, calcium, Vitamin B12, iron, and
vitamins which are absorbed with fat (A,D,E,K). You will also need to increase
the amount of protein in your diet according to your nutritionist, since the
amount of food you will be eating is much less. Blood tests are performed every 3
months for the first year to check your nutritional status.
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