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Home > Wellness > Health Library > Biliopancreatic Diversion and Biliopancreatic Diversion With Duodenal Switch
A biliopancreatic diversion changes the normal
process of digestion by making the stomach smaller. It allows food to bypass
part of the small intestine so that you absorb fewer calories. Because of the risks, this surgery is only done in people who are severely obese and who haven't been able to lose weight any other way. Severe obesity means that you have a BMI (body mass index) of 50 or higher.
After surgery, you will feel full more quickly than when your stomach was its original size. This reduces the amount of food you will want to eat. Bypassing part of the intestine also means that you will absorb fewer calories.
This leads to weight loss. But your best chance of keeping weight off after surgery is by adopting healthy habits, such as healthy eating and regular physical activity.
There are two biliopancreatic diversion
surgeries: a biliopancreatic diversion and a biliopancreatic diversion with
duodenal switch. Most surgeons will not perform duodenal switch surgery unless you are severely obese (BMI of 50 or higher) and your weight is causing serious health problems.
These procedures can be done by making a large cut in
the belly (an open procedure) or by making a small cut and using small
tools and a camera to guide the surgery (laparoscopy).
You will have some belly pain and may need pain medicine for the first week or so after surgery. The cut that the doctor makes (incision) may be tender and sore.
Because the surgery makes your stomach smaller, you will get full more quickly when you eat. Food also may empty into the small intestine too quickly. This is called dumping syndrome. It can cause diarrhea and make you feel faint, shaky, and nauseated. It also can make it hard for your body to get enough nutrition. Having a duodenal switch reduces the risk of dumping syndrome.
Your doctor will
give you specific instructions about what to eat after the surgery. For about the
first month after surgery, your stomach can only handle small amounts of soft foods and liquids while you are healing. It is important to
try to sip water throughout the day to avoid becoming dehydrated. You may
notice that your bowel movements are not regular right after your surgery. This
is common. Try to avoid constipation and straining with bowel movements.
Bit by bit, you will be able to add solid foods back into your diet. You
must be careful to chew food well and to stop eating when you feel full. This
can take some getting used to, because you will feel full after eating much
less food than you are used to eating. If you do not chew your food well or do
not stop eating soon enough, you may feel discomfort or nausea and may
sometimes vomit. If you drink a lot of high calorie liquid such as soda or
fruit juice, you may not lose weight. If you continually overeat, the stomach may
stretch. If your stomach stretches, you will not benefit from your surgery.
This surgery removes the part of the intestine where many
minerals and vitamins are most easily absorbed. Because of this,
you may have a deficiency in iron, calcium, magnesium, or vitamins. It's important to make sure you get enough nutrients in your daily meals to prevent vitamin and mineral deficiencies. You may need to work with a dietitian to plan
meals. And you may need to take extra vitamin B12.
Depending on how the surgery was done (open or laparoscopic) you'll have to watch your activity during recovery. If you had open surgery, avoid heavy lifting or strenuous exercise while you are recovering so that your belly can heal. In this case, you will probably be able to return to work or your normal routine in 4 to 6 weeks.
Weight loss surgery is suitable for people who are severely
overweight and who have not been able to lose weight with diet, exercise, or
Surgery is generally considered when your
body mass index (BMI) is 40 or higher. Surgery may
also be an option when your BMI is 35 or higher and you have a life-threatening
or disabling problem that is related to your weight.
It is important to think of this surgery as a tool to
help you lose weight. It is not an instant fix. You will still need to eat a
healthy diet and get regular exercise. This will help you reach your weight
goal and avoid regaining the weight you lose.
Biliopancreatic diversion surgeries
are effective. Most people lose 75% to 80% of their excess weight (the weight
above what is considered healthy) and stay at their new weight.1 Ten years after weight loss surgery, many people have gained back 20% to 25% of the weight they lost. The long-term success is highest in people who are realistic about how much weight will be lost, keep appointments with the medical team, follow the recommended eating plan, and are physically active.2
Risks common to all surgeries for weight loss
include an infection in the incision, a leak from the stomach into the
abdominal cavity or where the intestine is connected (resulting in an infection
peritonitis), and a blood clot in the legs (deep vein thrombosis, or DVT) or lung (pulmonary embolism). Some people develop
gallstones or a nutritional deficiency condition such
Biliopancreatic diversion surgery has short-term and long-term risks, including:
Weight loss surgery does not remove fatty tissue. It is not cosmetic surgery.
Some studies show that people who have
weight-loss surgery are less likely to die from heart problems, diabetes,
or cancer compared to obese people who did not have the surgery.3
Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
Colquitt JL, et al. (2009) Surgery for Obesity. Cochrane Database of Systematic Reviews (2).
Heber D, et al. (2010). Endocrine and nutritional management
of the post-bariatric surgery patient:
An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism, 95(11): 4823–4843. Available online: http://www.endo-society.org/guidelines/final/upload/FINAL-Standalone-Post-Bariatric-Surgery-Guideline-Color.pdf.
Adams TD, et al. (2007). Long-term mortality after
gastric bypass surgery. JAMA, 357(8): 753–761.
April 6, 2011
E. Gregory Thompson, MD - Internal Medicine & Ali Tavakkolizadeh, MD, FRCS - General Surgery, Bariatric Surgery
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