Biliopancreatic Diversion with
Duodenal Switch (BP-DS)

The Biliopancreatic Diversion with Duodenal Switch (BP-DS) is a restrictive and malabsorptive, and metabolic surgery. Therefore, it restricts food intake and reduces calorie absorption. The first part of the operation involves removing a large part of the stomach, leaving behind a smaller stomach that resembles a long tube (gastric sleeve) and re-routing of the small bowels to create a condition where fat is not absorbed. Side effects include multiple bowel movements daily and malabsorptive deficiencies that must be closely monitored postoperatively. It is an effective surgery for patents with diabetes and lipid abnormalities. In the second part of the operation, the small intestine is divided and reconnected farther down the digestive tract. The estimated weight loss for this procedure is 85 to 90% of excess weight.

This procedure is complex but can be done safely and laparoscopically. In addition, this procedure can now be performed using robotic technology.

In comparison to the laparoscopic approach, the robotic-assisted technique allows the surgeon to have more range of motion, more dexterity, and provides the surgeon with a three-dimensional perspective at higher magnification. Although Medicare has begun to pay for the open duodenal switch, it does not pay for the surgery if the procedure is performed laparoscopically or using robotic-assisted technology.

Whether the duodenal switch is done open, laparoscopic, or using robotic technology, this surgery is not only an effective primary procedure for weight loss but also an effective revision procedure for failed, previous weight loss surgery.