This is the most effective bariatric/ metabolic surgery since hormonal changes are very high. Gastric sleeve is formed using staplers. First part of small intestine (duodenum) is disconnected and attached todistal ileum (Last part of small intestine) in a Roux en y fashion.

 Weight loss and diabetes remission after BPD DS is mainly due to hormonal and genetic changes. Role of food restriction or malabsorption is secondary. After this operation Ghrelin hormone levels come down as fundus of the stomach is removed. GLP 1, Peptide YY hormone levels increase as food directly enters from 1st part of duodenum into distalileum (last part of small intestine). Food doesnt enter the remaining duodenum, jejunum and proximal ileum. So levels of anti incretin hormones come down. There will be more than 200 hormonal changes after surgery. Removal of body of stomach alters several genes involved in energy balance. These hormonal and genetic changes reduce appetite, increase energy expenditure and reset the fat mass’ to a lower level, resulting in long lasting, effective weight loss. Same hormonal changes are responsible for long lasting type 2 diabetes remission. Ghrelin and anti incretins act against insulin. As levels of these hormones come down, insulin resistance comes down. Since GLP 1 hormone is increased, insulin production increases and insulin resistance comes down. Significant diversion of biliopancreatic juices also contributes to the metabolic effects of this surgery.

   Hormonal and genetic changes responsible for long lasting weight loss and durable diabetes remission are very high in BPD DS compared to sleeve gastrectomy, roux en y gastric bypassor mini gastric bypass – one anastomosis gastric bypass. So weight loss is more effective & long lasting and diabetes remission is more& durable. Chances of weight regain and diabetes recurrence are very low. If anyone regains weight after sleeve gastrectomy or gastric bypass, revision to duodenal switch induces further hormonal changes necessary for weight loss and diabetes remission.

Since most of the small intestine is bypassed, risk of protein energy malnutrition, malabsorption, vitamin and mineral deficiencies are very high after BPD DS. Patients can develop foul smelling sticky stools, diarrhea and incontinence after BPD DS as fat is not absorbed. There is risk of formation of renal stones. Single anastomosis duodenoileal bypass with sleeve (SADI S) is a loop modification of BPD DS. This modification reduces malabsorption without compromising efficacy of surgery



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Laparoscopic biliopancreatic diversion with duodenal switch

(Laparoscopic BPDDS)

 (Drawn by Dr. V. Amar)


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