Biliopancreatic Diversion with Duodenal Switch

The Biliopancreatic Diversion with Duodenal Switch is a procedure that has two components that essentially combine the Sleeve Gastrectomy and Gastric Bypass. First, a smaller, banana shaped stomach pouch is created by removing a portion of the stomach, much like the Sleeve Gastrectomy. Next, a large portion of the small intestine is bypassed.

How Does it Work?

The first portion of the small intestine (know as the duodenum), is divided just past the outlet of the stomach. A portion of the small intestine (the last portion) 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 banana shaped stomach pouch and directly into the last segment of the small intestine. Roughly three quarters of the small intestine is bypassed by the food.

The bypassed small intestine, which carries the bile and pancreatic enzymes that are necessary for the breakdown and absorption of protein and fat, is reconnected to the last portion of the small intestine so that they can eventually mix with the food stream. Similar to the other surgeries, this initially helps to reduce the amount of food that is consumed. However, over time the impact lessens and patients are able to eventually eat near “normal” amounts of food.

Also, because the food does not mix with the bile and pancreatic enzymes until much further down the small intestine, the result is a significant decrease in the body’s ability to absorb calories and nutrients which requires patients to take supplements to address this deficiency. Finally, similar to the Gastric Bypass and Sleeve Gastrectomy, this surgery affects gut hormones in a way that impacts hunger and satiety as well as blood sugar control. This surgery is considered to be the most effective for the treatment of diabetes.