Laparoscopic Duodenal Switch

Biliopancreatic Diversion with Duodenal Switch (BPD/DS): A Malabsorptive Procedure

Malabsorptive procedures reduce the size of the stomach. However, the pouch is a bit larger than with other procedures. The pouch is connected to the lower part of the small intestine. Connecting to the lower part of the small intestine means that absorption of calories and nutrients is reduced greatly. While there are a number of different malabsorptive procedures performed worldwide, we perform the Biliopancreatic Diversion with Duodenal Switch, also known more commonly as the Duodenal Switch. This procedure is one of the three operations for morbid obesity outlined by the American Society for Bariatric Surgery.

Biliopancreatic Diversion with Duodenal Switch
In this version of BPD, stomach removal is limited to the outer margin, which creates a sleeve of stomach. The duodenum, the first portion of the small intestine, is divided so that pancreatic and bile drainage are bypassed.


  • BPD has the highest rate of type 2 diabetes resolution of all the different bariatric surgery procedures: 98.9 percent.
  • 75.1 percent of hypertension cases are resolved or improved.
  • 91.9 percent of sleep apnea cases are resolved.
  • Excess weight loss is roughly 70.1 percent.
  • These operations often result in a high degree of patient satisfaction because patients are able to eat larger meals than with a purely restrictive or standard Roux-en-Y gastric bypass procedure.
  • These procedures can produce the greatest weight loss because they have the highest rates of malabsorption.
  • Long-term maintenance of excess body weight loss can be successful if the patient adjusts to and maintains an easy-to-follow dietary, supplement, exercise, and behavioral routine.
  • As with every type of bariatric surgery, the overall quality of life for patients improves greatly. A great deal of excess weight is lost, and patients experience resolution of co-morbidities, and improved appearance, social opportunities, and economic opportunities.

Risks and Disadvantages

  • There is a period when the intestines adjust and bowel movements can be very liquid and frequent. This condition may lessen over time, but may be a lifelong condition.
  • Abdominal bloating and foul-smelling stool or gas may occur.
  • Patients and their primary care physicians should monitor for protein malnutrition, anemia, and bone disease throughout the patient's life. Patients also need to take vitamin supplements for the rest of their lives. Not taking either of these precautions can lead to health issues that require treatment. In fact, it's been found that if patients do not follow eating and vitamin supplement instructions closely, at least 25 percent will develop problems that require treatment.
  • Changes to the intestinal structure can increase the risk of forming gallstones and the need for removal of the gallbladder.
  • Patients should be aware of the possibilities of intestinal irritation and ulcers.


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