Biliopancreatic Diversion with Duodenal Switch is also called Vertical
Gastrectomy with Duodenal Switch, the Scopinaro procedure, the Duodenal
Switch procedure, the DS or BPD-DS. This procedure was developed
by Professor Nicola Scopinaro in Italy and has been performed since
1979. It generates weight loss by combining of restrictive and malabsorptive
techniques. Restrictive component of the operation allows an individual
to eat small portion meals to achieve feeling of being full. The
malabsorptive component of the operation limits the amount of food,
specifically fat, that is absorbed into the body. The Duodenal Switch
procedure is controversial because it creates a great deal of malabsorption,
which augments and maintains long-term weight loss. Of the procedures
that are currently performed for the treatment of obesity, the Duodenal
Switch procedure seems to be the most powerful and effective, but
is also associated with most side effects.
In the Duodenal Switch(DS) operation, the surgeon removes approximately
85 percent of the stomach so the remaining stomach takes the shape
of a tube or "sleeve". The part of the stomach that is most susceptible
to stretching and relaxing is removed reducing stomach's volume.
The stomach that remains measures from 4-7 ounces (120-250 cc).
The nerves to the stomach and to its outlet valve, pylorus, are
kept intact to preserve the functions of the stomach. With DS operation
normal gastro-duodenal emptying is maintained; latter avoids or
decreases complications of dumping syndrome, gastritis and "marginal
ulcers" since the stomach is not connected directly to the small
intestine. To create malabsorption, the intestines are divided and
rearranged to separate food from the digestive juices. The food
limb is attached to the duodenum and receives food from the stomach.
This limb is 150 cm long. The digestive juices are now separated
from the food and travel through the bypassed small intestine. Both
food and digestive juices mix together and travel together for about
100 cm in the common limb. Thus, food and digestive juices are separated
for most of the length of the intestines. In the BPD-DS patients,
the digestion and obsorption can only take place with in this 100
cm of common channel. Latter prevents patients who have undergone
this surgery from absorbing all of the calories that are eaten,
specially fats. By comparison, the Roux-en-Y gastric bypass has
more restriction and less malabsorption then the Duodenal Switch
Advantages of the Biliopancreatic Diversion with Duodenal Switch
- This operation results 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.
- The BPD-DS procedure can produce the greatest excess weight
loss because it provides the highest levels of malabsorption.
- In one study of 125 patients, excess weight loss of 74% at
one year, 78% at two years, 81% at three years, 84% at four years,
and 91% at five years was achieved.
- Long-term maintenance of excess body weight loss can be successful
if the patient adapts and adheres to a straightforward dietary,
supplement, exercise and behavioral regimen.
The Biliopancreatic Diversion with Duodenal Switch operation requires
close lifelong monitoring for protein malnutrition, anemia and bone
disease. As with all weight loss operations, lifelong vitamin supplementing
is required. It has been generally observed that if eating and vitamin
supplement instructions are not rigorously followed, at least 25%
of patients will develop problems that require treatment. The DS
operation, is a well documented operation that is reserved for individual
who is able to appreciate and comply with the absolute necessity
of following instructed dietary guidelines, taking daily vitamin
supplements and life long post operative care.