Biliopancreatic Diversion

What You need to Know About Biliopancreatic Diversion (BPD/DS)

Biliopancreatic Diversion with Duodenal Switch (BPD/DS) is now an approved procedure for weight loss for the treatment of morbid obesity. Nicola Scorpinaro started the Biliopancreatic Diversion over 40 years ago in Italy. It created a moderately large proximal gastric pouch and removed the distal stomach. A Roux-en-Y limb of intestine then connected this pouch to the intestine composed of the duodenum and all of the jejunum and some of the ileum in a “Y” type hook up to form a short common channel, bypassing about 60% of the small bowel to create malabsorption. Although there was excellent weight loss and it corrected many of the problems with the intestinal bypass of old, there was still a moderate degree of marginal ulcers and protein calorie malnutrition. Although it worked fairly well for Dr Scopinaro, these problems made this procedure too risky to approve in the United States.

In 1989, Douglass Hess used the knowledge of this procedure and made a couple changes. He created a stomach tube instead of a proximal gastric pouch, giving the restrictive component of the procedure, and transected the duodenum and connected the proximal duodenum to the ileum, achieving the same malabsorptive component. This corrected the marginal ulcer problem (and in fact, the incidence of marginal ulcers with the Duodenal Switch is much less than with the Roux-en-Y Gastric Bypass,) and reduced the protein-calorie malnutrition problem.

He started this as a revisional operation for those who failed other weight loss operations and it showed great success. Later he started performing it as a primary operation. Its popularity was initially marginal because it was a difficult operation, it was not well understood and was constantly grouped with Dr Scopinaro’s BPD which had a too many unwanted complications. Slowly, however, many weight loss surgical groups throughout the world started performing it and the results were extremely good.

In 2006, a group of surgeons brought their results of well over 100,000 patients to Washington and presented them to the Center For Medicare and Medicaid Services and it finally gained approval after almost 30 years.

The response from Walter J. Pories, MD Posted on 03/08/2001 “The Biliopancreatic Diversion with Duodenal Switch is a relatively new procedure that has yet to be shown as safe and effective in long term studies”(1)—don’t know where this quote was taken---, has been brought to the test and has now been shown not only to be safe and effective in long term studies, but may in fact be the most superior operation for the conscientious patient.

The indications for this procedure is the same as that for all of the other weight loss procedures---BMI of 40 and over, and a BMI of 35 and over with life threatening co-morbidities. It is particularly indicated for super (BMI over 50) and super, super (BMI over 60) morbid obesity. Some feel it is a too risky and involved procedure for those of lower BMI’s. And yes, the mortality of the DS is about .75 % where as the mortality of the GBP is about .3 % and for the LAGB (Laparoscopic Adjustable Gastric Band) it is about .1%, but the lifestyle of being able to eat more normally and not have dumping may make patients desire this even if they do not have extreme obesity. Where the risks are somewhat greater with this operation, the average weight loss also increases with this operation compared to the others. The LAGB has an average excess weight loss of 40-50%, the RYBG has an average excess weight loss of 60-70%, and the DS has an average excess weight loss of 80-90%.

Now, in meetings of the DS doctors recently in Washington, DC at the ASMBS, the Duodenal Switch is referred to as the “Platinum Standard” for Weight Loss Surgery, as its results in overall weight loss and general quality of life appear to be superior to that of the Roux-En-Y Gastric Bypass which has been termed the “Gold Standard”