Biliopancreatic Diversion with Duodenal Switch (BPD-DS)

What is Duodenal Switch Surgery?

The duodenal switch weight loss surgery, or biliopancreatic diversion with duodenal switch (BPD-DS), is a procedure that helps shorten the path food follows through the small intestine. In turn, this reduces the amount of time your body has to absorb calories from the food you eat to help you lose weight.

This type of surgery is one of the most complex bariatric surgeries. However, it can help you lose more weight than either gastric bypass (Roux-en-Y gastric bypass) or sleeve gastrectomy (gastric sleeve surgery) alone. It has also been shown to help reduce obesity-related illnesses and health problems, such as type 2 diabetes, sleep apnea and heart disease.

How is Duodenal Switch Surgery Performed?

Duodenal switch surgery is usually a laparoscopic procedure. This means our bariatric surgeons can do the surgery with small tools inserted through a few tiny incisions in your abdomen.

The complex procedure tackles weight loss with the use of two parts – a sleeve gastrectomy and an intestinal bypass (rerouting the intestines):

• In the first part of the procedure, the surgeon removes a large portion of the stomach with a stapling instrument, leaving a small sleeve or stomach pouch (sleeve gastrectomy). With less stomach to fill, you will feel full more quickly and, in turn, eat less food and fewer calories. 
• The second part of the procedure reroutes food away from the upper part of the small intestine, which is the natural path of digestion. The small intestine is divided into two sections.

One portion of the small intestine, called the alimentary limb, is connected to the stomach pouch. The food you eat travels through this segment. This cuts back on how many calories and nutrients your body is able to absorb.

The second section, called the biliopancreatic limb, keeps digestive juices from the gallbladder and pancreas separate until the two sections join at the common channel. This cuts back on how many calories you absorb, causing still more weight loss. One end of the small intestine is connected to the duodenum, near the bottom of the stomach.

Once the surgery is complete, the food from the stomach will now move through about 10 feet of the small intestine instead of 20, reducing the time it takes for the body to absorb calories and nutrients, prompting weight loss.

Who is a Candidate for Duodenal Switch Surgery?

This procedure is recommended for people who are severely obese, those who have a body mass index (BMI) of 50 or greater or a BMI of 40 or greater with serious type 2 diabetes and other serious medical conditions.

These health problems may include:

• Sleep apnea
• Heart disease
• High blood pressure or cholesterol
• Nonalcoholic fatty liver disease
• Lung disease

Follow the BMI calculator to find out if you’re a healthy weight.

What are the Advantages?

The duodenal switch procedure offers several key benefits:

• Greater weight loss. The average excess weight loss is generally greater than with other weight loss surgeries. People can lose up to 40% of total weight  .
• Less risk for dumping syndrome. The duodenal switch keeps a muscle called the pylorus that controls the emptying of the stomach, so dumping syndrome is unusual. Dumping occurs when food, especially sugar, moves too quickly from the stomach to the duodenum.
• Improved health. The weight loss results from the procedure have been shown to help control and reverse type 2 diabetes and reduce high blood pressure, sleep apnea and cholesterol.
• No food restrictions. Your remaining stomach is larger after the duodenal switch than with gastric bypass, allowing you to eat “normal” meals.

What are the Risks?

While the procedure helps many lose weight, it’s not the right choice for everyone. In addition to the general risks of surgery, the duodenal switch comes with the following potential risks:

• Poor nutrition. Bypassing a large part of your intestine limits your body’s absorption of important nutrients, vitamins and minerals, such as protein, fat-soluble vitamins (A, E, D and K), iron, calcium, vitamin B-12 and folic acid. This can put people at greater risk of developing anemia, osteoporosis or kidney stones. You will have to take vitamin and protein supplements and have regular blood testing for the rest of your life. This is to prevent severe vitamin deficiencies and related complications. You should work closely with your bariatric team to monitor your health.
• Not for smokers. It’s important to note that smokers are not candidates for duodenal switch surgery as smoking puts people at an increased risk for infections, blood clots, slow healing and other life-threatening complications.
• Bowel changes. Changes to the intestinal structure can cause bloating, diarrhea, foul-smelling stool (poop) or gas and an increased risk of gallstones and gallbladder disease.

What Happens After Duodenal Switch Surgery?

After duodenal switch surgery, you can continue to lose weight or maintain weight loss by eating a healthy diet and exercising regularly. You will also need to regularly follow up with your provider for guidance on your diet and exercise plan. There are free support groups available before and after surgery as well.

It is recommended that patients take the following measures to support long-term health after surgery:

• Eat a healthy diet and take the right vitamins and minerals.
• Work with a dietitian to create a healthy eating plan.
• Continue with follow-up diet, exercise and behavioral health programs.

Learn more about the Bariatric Surgery Journey (life pre- to post-surgery).

Our Expert Bariatric Team

Bariatric surgery needs a multidisciplinary approach to obesity care. The Banner Health weight loss team offers compassionate, comprehensive and advanced care. Our team is dedicated to providing you with the safest, most successful bariatric patient experience possible.

Surgery is only one part of that care. Equally important is the education, lifelong follow-up and support our team provides. Our team partners with you to achieve your weight loss goals and improve your quality of life.

Your team will involve a surgeon or surgeons, obesity medicine doctors, nurse practitioners, nurses, dietitians, behavioral health specialists, support staff, medical assistants and some specialists in cardiology, pulmonology and sleep medicine. We are all working together with you on your care.

Take the Next Step: Am I a Candidate? 

Bariatric Center of Excellence

Banner Health is accredited by the American Society of Metabolic and Bariatric Surgery for its high standards of care in weight loss surgery.