Question:
I would like to know the PHYSICAL DIFFERENCE between the BPD/DS and the BPD.

The information I have found here does not give a lot of detail. I have been reading about people who have had the BPD with no DS and am wondering if it is safer. If not, then why? Thanks, Annie    — annie W. (posted on July 31, 2003)

July 31, 2003
Annie: The BPD is an older surgery that the DS was 'built upon'. It is still performed, however and *might* be better for some patients - especially those who have experienced extreme ulcers. The DS is certainly more difficult to perform because of the first cut in the duodenum (the tissue here can be difficult to work with). BOTH the stomach and intestinal part of the BPD and DS are different (the DS is also referred to as the BPD-DS but it is not just the BPD with a little 'DS' added on - the stomach portion is TOTALLY different). In the BPD, the bottom portion of the stomach is removed. This area is where most of the acid is produced. This is why the BPD-type stomach removal was commonly used to treat chronic ulcers. A note of caution: Such removal *has* been shown to slightly increase pancreatic and stomach cancer risks (as evidenced in ulcer patients who had this type of stomach removal). The pylorus is also removed. A 'stoma' is created and the intestines are hooked up. The difference with the RNY is that this stomach is much larger than the pouch. The stomach isn't cut or stapled into two portions -- the lower part of it is totally removed. Also, the higher malapsorption makes up for the larger stomach so patients lose weight and keep it off (with proper diet and exercise, of course). But, one can eat 'normal size' portions with the BPD and the 'pouch rules' may not be totally applicable (although the stuff about the stoma may apply). The intestines are split into two 'limbs': One carries bilio-pancreatic juices from the gallbladder/pancreas. The other, which is connected to the stomach, carries the chyme (semi-processed food). These two limbs connect together in the last portion of the small intestines called the 'common channel'. In the traditional BPD, it is 50 cm long. Some drawbacks some post-ops experienced with this surgery: Dumping, halitosis (bad breath) that some thought was due to the stoma area and the stomach not being able to totally 'close off' from the intestines, malabsorption of critical nutrients: Since calcium, B-12, iron all are primarily absorbed in the duodenum and this area was totally bypassed with the BPD (as with the RNY), patients could show deficiencies. Also, since the common channel was 50 cm, they also could show potentially dangerously low levels of fat soluable A, D (sometimes E, K). Protein deficiency was also noted. Diahhrea and loose bowels (with possible foul smell) were also noted because of the shorter common channel. NOw, not ALL patients showed all (or any) of these symptoms. But, the DS was created to alleviate such symptoms. IN the DS, the stomach is partially removed but it is a totally different part: The fundus or area where food is 'stored' on the side is removed. The stomach is left in it's 'natural' banana shape and the lower portion (which processes the food with acid, etc.) and the pylorus remain intact. So, the DS patient's stomach acts as it did pre-op: The stomach functionally processes the food, the pylorus relases it into the intestines when it is finished, etc. I don't think it's just the physical process but all the neurological signals remain the same: The digestive system is very complex and involves a lot of neuroligical interactions. With the DS, I think a lot of patients exerience 'saiety' because they have the entire set of signals (like pre=op) that signal fullness, experience 'release' into the duodenum (from the research I've read this is actually where 'saiety' occurs -- there is a nervous signal that goes to the brain when chyme enters the duodenem). Unlike the BPD or RNY, the DS leaves a portion of the duodenum intact (about 3-5 cm). Then, the intestines are split into the two limbs. Because of this, DS patients do not dump, the risk of halitosis is reduced, essential vitamins like iron, calcium, B-12 are somewhat more absorbed (but we still need to supplement). On the other end, the DS surgery *usually* involves a 'standard' 100 cm common channel (although some surgeons may make it smaller or measure to 'taailor' to each patient). This is supposed to reduce the risk of chronic diahhrea, increase absorption of the fat soluable vitaimns (but manys surgeons feel supplementation is still necessary). It also increases protein absorption. I hope this helps! There is a further explanation of the BPD/DS with great links on www.duodenalswitch.com (it has patient experiences, etc. as well). I chose the DS mainly because I wanted to keep my digestive system functioning as closely to pre-op as possible. I personally did not like the idea of having a stoma or totally bypassing the duodenum, since that area of the intestines is so specialized and essential. Granted, I only kept a few cm of it, but the other surgical options (that had a malapsorptive component) bypassed it. I did not want to experience dumping but preferred to learn to eat nutritiously -- it's all in the head in the end. That is what has to change, with or without dumping. I wanted the maximum absorption to get all the weight off and keep it off. I know that I will be on heavy vitamin supplementation for life as a result. Since I take most of my pills during meals, it really wasn't a problem for me. As far as safety is concerned, I don't think the BPD is any safer than the DS. The DS is a much more difficult surgery to perform. The DS portion can be tricky and sometimes can provide problems immediately post-op (leaks in this area in particular). I have yet to read ANYTING about the DS being more 'dangerous', except perhaps the fact that it may be considered more 'dangerous' to perform by some surgeons because of it's difficulty. In terms of post-op lifestyle, it offers the alleviation of some of the potential side effects of the BPD. I've read that some surgeons question the use of the pylorus or having the duodenal stump, arguing 'it really doesn't make a difference'. I think it does. There really hasn't been a lot of research on this, but hopefully there will be in teh future. The DS offers better absorption of calcium, B-12, iron, the fat soluable ADEK vitamins, protein. It is supposed to decrease the incidence of chronic diahhrea (although some with shorter common channels of 50 cm do not experience this). One does not have the issues of the stoma, adjusting eating styles to accomodate the stoma, worry about the potential blockage of the stoma. You have stomach acid which aids pre-digestion - this is good for vitamin supplements, meds as well as food. Hope this helps! All the best, Teresa (preop: 307 lbs/bmi 45 now: 160 lbs/bmi 23 5'10", 2 1/2 years post-op)
   — Teresa N.