BPD DS, DUODENAL SWITCH
BILIOPANCREATIC DIVERSION WITH DUODENAL SWITCH
(BPD DS, DUODENAL SWITCH)
– One of the most advanced and effective bariatric & metabolic surgery for the treatment of severe obesity and severe diabetes.
– This and Loop Duodenal Switch are the most powerful sleeve plus bypass combination surgeries.
– Physiological changes are significantly high after BPD DS, compared to standard bariatric & metabolic surgeries.
- Performed by robotic or laparoscopic method (By putting small holes over the tummy) using advanced high quality imported laparoscopic equipment and instruments.
- Up to 80% of the stomach is removed using high quality staplers and stapler guns to form a vertical sleeve.
- When the stomach is divided using staplers, it is stapled in three rows, sealed and cut simultaneously.
- The percentage of the removed stomach is relative but the capacity of the remaining gastric sleeve is 60 to 100 ml.
- Duodenum (First part of the small intestine) is divided and attached to the distal ileum (Last part of small intestine) in a Roux en y fashion.
– In India and Asia,
- Individuals suffering from severe obesity with the body mass index is ≥ 32.5 kg/m2 with co-morbid medical conditions such as type 2 diabetes.
- Individuals suffering from severe obesity with the body mass index is ≥ 37.5 kg/m2 even without any co-morbid medical conditions.
– In Western countries
- Individuals suffering from severe obesity with the body mass index is ≥ 35 kg/m2 with co-morbid medical conditions such as type 2 diabetes.
- Individuals suffering from severe obesity with the body mass index is ≥ 40 kg/m2 even without any co-morbid medical conditions.
– Weight loss is mainly due to physiological changes altering body energy balance.
– Because of these changes
- Appetite (Hunger) is reduced.
- Metabolic rate is increased.
- Energy expenditure is increased.
- ‘Fat mass’ is reset to a lower level.
- Fat starts melting as body doesn’t want to store large quantity of fat.
- You don’t eat large quantity of food as you start hating unhealthy foods.
– Physiological changes are significantly high as undigested food directly enters the distal ileum.
– Diversion of the biliopancreatic juices contribute further to these physiological changes.
– Role of food restriction and malabsorption is secondary.
– Same physiological changes are responsible for type 2 diabetes remission.
- Insulin resistance is reduced.
- Insulin production is optimised to control blood sugars.
– Average excess weight loss is > 90%.
– Some may lose above average, even 100% of the excess weight loss.
– For Example – If you are 50 kg excess weight, you lose approximately > 45 kg on average. Some may lose all the extra 50 kg.
– Generally if your weight burden is less, you lose more percentage of excess weight and if your weight burden is more you lose less percentage of excess weight.
– Average Total weight loss percentage > 40%.
– Average diabetes remission is > 90%.
– It is necessary to follow lifestyle modifications to improve weight loss and diabetes remission and to prevent weight regain and diabetes recurrence.
– Results in long lasting and significant weight loss.
– Results in long lasting and effective diabetes remission.
– Physiological changes are very high in Biliopancreatic diversion with duodenal switch as longer small intestine is bypassed compared to the standard Gastric sleeve (SG), Roux en y gastric bypass (RYGB) or mini gastric bypass – one anastomosis gastric bypass (MGB – OAGB), and Sleeve with bypass combination procedures such as Sleeve with duodenojejunal bypass (SG DJB), Sleeve with proximal jejunal bypass (SG PJB), Sleeve with jejunoileal anastomosis (SG JIA), Sleeve with Jejunoileal Interposition (SG JII), Sleeve with Duodenoileal Interposition (SG DII), Sleeve with loop duodenojejunal bypass (SG LDJB) or Single Anastomosis Sleeve Ileal Bypass (SASI Bypass).
– Weight loss is more effective & long lasting after BPD DS compared to the standard SG, RYGB or MGB – OAGB, and Sleeve with bypass combination procedures such as SG DJB, SG PJB, SG JIA, SG JII, SG DII, SG LDJB or SASI Bypass.
– Diabetes remission is significantly high & durable after Duodenal switch compared to the standard SG, RYGB or MGB – OAGB, and Sleeve with bypass combination procedures such as SG DJB, SG PJB, SG JIA, SG JII, SG DII, SG LDJB or SASI Bypass.
– Average weight regain after Biliopancreatic diversion with duodenal switch is very low (< 5%).
– Average diabetes recurrence after BPD DS is very low (< 5%).
– BPD DS has several advantages compared to RYGB and MGB – OAGB.
- There is no ‘at risk’ stomach remnant.
- Calcium and iron deficiency risk is low since first part of the duodenum is not bypassed
- Risk of dumping syndrome is less because of intact pylorus controlling food out put
- There is no risk of marginal ulcers
- Risk of internal hernias is low.
– BPD DS is technically more advanced, complex and time taking compared to SG, RYGB and MGB – OAGB.
– It needs advanced laparoscopic surgical skills and training.
– Risk of protein energy malnutrition, malabsorption, vitamin and mineral deficiencies are very high, since most of the small intestine is bypassed after BPD DS.
– Fat malabsorption leads to foul smelling sticky stools, diarrhea and incontinence.
– Increased risk of renal stones.
– It is not possible to access common bile duct (pipe below liver) by endoscopy.
– Robotic, Laparoscopic single anastomosis duodenoileal bypass with sleeve (SADI S) is a loop modification of Duodenal switch. This modification reduces malabsorption significantly without compromising the efficacy of surgery.
– Some may lose below average. Inadequate weight loss < 1%. They may lose only 5 to 10 kg and stop losing further.
– It is very very safe procedure.
– It is a life saving surgery.
– Severe obesity and severe diabetes are dangerous.
– Bariatric and Metabolic surgeries are very safe.
– Complications are very rare. Even if they occur, they can be rectified.