The Biliopancreatic Diversion with Duodenal Switch (BPD/DS) has two parts to it, as well. First a portion of the stomach is created to form a tube-shaped pouch (similar to sleeve gastrectomy). Second, a major portion of the small intestine is bypassed. What this does is restricts the amount of food the stomach can hold and promotes fullness faster. It also reduces the absorption of nutrients. It is a highly effective surgery, but it also involves greater risk, such as vitamin deficiencies or malnutrition.
• Why it's done
A BPD/DS is done to help you lose excess weight and reduce your risk of potentially life-threatening weight-related health problems, including:
- Heart disease
- High blood pressure
- High cholesterol
- Severe sleep apnea
- Type 2 diabetes
- Stroke
- Infertility
A BPD/DS is typically done only after you’ve tried to lose weight by improving your diet and exercise habits.
But a BPD/DS isn’t for everyone who is severely overweight. You likely will have an extensive screening process to see if you qualify.
You must also be willing to make permanent changes to lead a healthier lifestyle both before and after surgery. This may include long-term follow-up plans that involve monitoring your nutrition, your lifestyle and behavior, and your medical conditions.
• Before the procedure
Before you go to the operating room, you will change into a gown and will be asked several questions by both doctors and nurses. In the operating room, you are given general anesthesia before your surgery begins. Anesthesia is medicine that keeps you asleep and comfortable during surgery.
• During the procedure
The specifics of your surgery depend on your individual situation and your doctor’s practices. Some surgeries are done with traditional large, or open, incisions in your abdomen, while some may be performed laparoscopically, which involves inserting instruments through multiple small incisions in your abdomen.
The first step of a BPD/DS. The first step in a BPD/DS involves removing a portion of the stomach. After making the incisions with the open or laparoscopic technique, your surgeon removes a large portion of the stomach and forms the remaining portion into a narrow sleeve. Your surgeon leaves intact the valve that releases food to the small intestine (the pyloric valve), along with a limited portion of the small intestine that normally connects to the stomach (duodenum).
The second step of a BPD/DS. During the second step, your surgeon makes one cut through the part of the small intestine just below the duodenum, and a second cut farther down, near the lower end of the small intestine. Then your surgeon brings the cut end near the bottom of the small intestine up to the other cut end, just below the duodenum. The effect is to bypass a large segment of the small intestine.
Each part of the surgery usually takes a few hours. After surgery, you awaken in a recovery room, where medical staff monitors you for any complications.
• After the procedure
Immediately after a BPD/DS procedure, you may have liquids but no solid food as your stomach and intestines begin to heal. You’ll then follow a special diet plan that changes slowly from liquids to pureed foods. After that, you can eat soft foods, then move on to firmer foods as your body is able to tolerate them.
Your diet after surgery may continue to be quite restricted, with specified limits on how much and what you can eat and drink. Your doctor will recommend that you take vitamin and mineral supplements after surgery, including a multivitamin, calcium and vitamin B12. These are vital to prevent micronutrient deficiency.
You’ll also have frequent medical checkups to monitor your health in the first several months after weight-loss surgery. You may need laboratory testing, bloodwork and various exams.
You may experience changes as your body reacts to the rapid weight loss in the first three to six months after a BPD/DS, including:
- Body aches
- Feeling tired, as if you have the flu
- Feeling cold
- Dry skin
- Hair thinning and hair loss
- Mood changes
