The BPD/DS combines restrictive and malabsorptive elements to achieve and maintain the best reported long-term percentage of excess weight loss among modern weight-loss surgery procedures.
The Restrictive Component
The BPD/DS procedure includes a partial gastrectomy, which reduces the stomach along the greater curvature, effectively restricting its capacity while maintaining its normal functionality.
Unlike the unmodified BPD and RNY, which both employ a gastric “pouch” and bypass the pyloric valve, the DS procedure keeps the pyloric valve intact. This eliminates the possibility of dumping syndrome, marginal ulcers, stoma closures and blockages, all of which can occur after other gastric bypass procedures.
In addition, unlike the unmodified BPD and RNY procedures, the DS procedure keeps a portion of the duodenum in the food stream. The preservation of the pylorus/duodenum pathway means that food is digested normally (to an optimally absorbable consistency) in the stomach before being excreted by the pylorus into the small intestine. As a result, the DS procedure enables more-normal absorption of many nutrients (including protein, calcium, iron and vitamin B12) than is seen after other gastric bypass procedures.
The Malabsorptive Component
The malabsorptive component of the BPD/DS procedure rearranges the small intestine to separate the flow of food from the flow of bile and pancreatic juices. This inhibits the absorption of calories and some nutrients. Further down the digestive tract, these divided intestinal paths are rejoined; food and digestive juices begin to mix, and limited fat absorption occurs in the common tract as the food continues on its path toward the large intestine.
For more detailed procedure information, see Dr. Hess’ patient brochure. For other detailed descriptions and illustrations, see the More Information page for links to surgeon’s websites and more.
History
The standalone Duodenal Switch procedure (without the accompanying gastric bypass as used in weight-loss surgery) was originally devised by Tom R. DeMeester, M.D. to treat bile gastritis, a condition in which the stomach and esophagus are burned by bile. In 1988, Dr. Douglas Hess of Bowling Green, Ohio, was the first surgeon to combine the DS with the Biliopancreatic Diversion (BPD) form of obesity surgery. This hybrid procedure, known as the Biliopancreatic Diversion with Duodenal Switch (or the Distal Gastric Bypass with Duodenal Switch), solves many nutritional problems associated with other forms of WLS, and allows a magnificent eating quality when compared to other WLS procedures.
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Published Clinical Reports
- In 1998, Dr. Hess of Bowling Green, Ohio, published a 10-year follow-up report on the first 440 patients to undergo his BPD/DS procedure (Hess, et al.: Biliopancreatic Diversion with a Duodenal Switch, Obesity Surgery, 8, 1998; 267-282.). This report concludes that this operation has vastly improved the lives of seriously obese patients with many co-morbidities. Furthermore, there has been no late regain of weight in this method.
- The BPD procedure (without the duodenal switch), on which the BPD/DS is based, was first performed in 1976 by Dr. Nicola Scopinaro of Italy. In 1998, Dr. Scopinaro published a 21-year follow-up report on a series of 2241 BPD patients (Scopinaro N, et al.: Biliopancreatic Diversion, World J Surg. 1998 Sep;22(9):936-46. PMID: 9717419; UI: 98383147.). This report concludes that the BPD is the most effective procedure for the surgical treatment of obesity.
- In 1993, Dr. Picard Marceau of Laval, Canada, published a report on the benefits of the BPD/DS procedure over the unmodified BPD (Marceau, P., S. Biron, et al. (1993). "Biliopancreatic Diversion with a New Type of Gastrectomy." Obes Surg 3: 29-35.). This report confirms that the DS procedure eliminates or greatly minimizes most negative side effects of the original BPD.
- In 1997, Dr. Robert Rabkin of San Francisco, California, published a report comparing results from three procedures including the DGB/DS (Rabkin RA. “Distal gastric bypass/duodenal switch procedure, Roux-en-Y gastric bypass and biliopancreatic diversion in a community practice.” Obes Surg. 1998 Feb;8(1):53-9.44). This report concludes that the DS procedure is an important option for primary treatment of morbid obesity, and that it can be performed safely, with long-term stable weight loss.
- In 1998, Dr. Picard Marceau, et al, published a detailed report on follow-up results from BPD and BPD/DS patients who underwent surgery as far back as thirteen years previously. (Marceau P; Hould FS; Simard S; Lebel S; Bourque RA; Potvin M, Biliopancreatic diversion with duodenal switch., World journal of surgery. 1998 Sep;22(9):947-54). This report summarizes results which illustrate the superiority of the DS enhancement over the original Scopinaro BPD procedure.
- In December 2000, Drs. Ren, Patterson and Gagner reported on results from their first 40 laparoscopic BPD/DS patients (Early results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients.Obes Surg. 2000 Dec;10(6):514-23). This report concludes that laparoscopic BPD-DS is a complex, yet feasible, procedure resulting in effective weight loss with an acceptable morbidity.
- In February 2001, Dr. Aniceto Baltasar of Alcoy, Spain published a report on his intermediate results with the Duodenal Switch procedure (“Duodenal Switch: an Effective Therapy for Morbid Obesity—Intermediate Results.” Obes Surg. 2001 Feb;11:54-59). This report found the DS procedure to be very effective for weight control in morbidly obese and super-morbidly obese individuals, with a very satisfactory post-op quality of life.
- In April 2002, Dr. Aniceto Baltasar of Alcoy, Spain published a report on his early results with 16 Laparoscopic Duodenal Switch patients (“Laparoscopic Biliopancreatic Diversion with Duodenal Switch: Technique and Initial Experience.” Obes Surg. April 2002). This report concludes that LapDS is an advanced, complex and feasible technique in bariatric surgery.
- In April 2003, Dr. Robert Rabkin, et al, published a report on his laparoscopic technique for performing the Duodenal Switch procedure (“Laparoscopic technique for performing duodenal switch with gastric reduction.” Obes Surg. 2003 Apr;13(2):263-8). This report concludes that this method has yields advantages including decreased pain, improved pulmonary function in the early postoperative period, reduced hospital stay, and a more pleasant cosmetic result.
- In April 2003, Dr. Gary Anthone, et al, published a study including 10 years experience with the Duodenal Switch procedure (The Duodenal Switch Operation for the Treatment of Morbid Obesity: A 10 Year Experience). This report concludes that the DS is a safe and effective primary procedure for the treatment of morbid obesity. It has the advantage of allowing acceptable alimentation with a minimum of side effects while producing and maintaining significant weight loss. These results are achieved without developing significant dietary restrictions or clinical metabolic or nutritional complications.
- More clinical data on the Duodenal Switch procedure can be found online at Pubmed by typing “duodenal switch” into search field there. PubMed, a service of the National Library of Medicine, provides access to over 11 million citations from MEDLINE and additional life science journals. PubMed includes links to many sites providing full text articles and other related resources.
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