Biliopancreatic Diversion/Duodenal Switch

Our group has extensive experience in performing laparoscopic duodenal switch operations. The duodenal switch (or, ‘Switch’) is the most effective operation for long term weight loss and has the lowest relapse rate. It does have the highest risk of vitamin deficiency. The Northern Westchester Hospital Team has been instrumental in popularizing a new version of the Switch that adds more restriction and reduces the number of daily bowel movements and malabsorbtion. Our group serves as teachers of this procedure and has several published videos that have been presented and available through the American College of Surgery.

The operation combines a Sleeve Gastrectomy, with an “intestinal bypass” with a Roux limb of 150 cm, common channel of 125 to 150 cm and the remainder bypassed from the food circuit. Compared to a Gastric Bypass, a BPD-DS re-routes the intestines to a greater degree.

Although the BPD-DS operation involves removing part of the stomach,the pyloric valve is preserved. This regulates the passage of stomach contents into the small intestines. By preserving the pylorus, there is a valve at the end of the stomach that controls emptying, making you feel full longer.

Weight loss results are excellent with patients losing up to 82% of their excess weight as far out as 12 years. Initial weight loss occurs because patients eat less, and long-term weight loss occurs because fat and carbohydrates are not completely absorbed (malabsorption), but sugars are. This procedure provides the most malabsorption of the weight loss procedures.

A recent study showed that duodenal Switch patients that had a BMI greater than 50 lost a significantly more weight than matched Gastric Bypass patients. At one year, those with a BMI of 55 reached a BMI of 32 with Switch, compared to BMI of 38 with Bypass. What is additionally important is that Switch patients lose weight between the first and third year, whereas Bypass patients on average regain some weight.

This data has made more surgeons interested in the Switch, yet few have the expertise to offer this procedure laparoscopically. That is why Dr. Roslin’s team is brought in to teach and proctor established surgeons all over the country such new procedures.

This is an operation that was popularized in Italy and later modified by surgeons in the US and Canada. With our Switch, most patients move their bowels between one and three times per day. Compared to old versions, we do not get complaints of uncontrolled BM’s and soiling. Blood work needs to be followed several times during the first year, and regularly after that. Patients must be compliant with their supplements or they will develop issues after the operation.

Benefits

• This procedure offers maximal weight loss which can be maintained long-term.
• Dumping Syndrome does NOT occur. Dumping is a physical reaction in which food is “dumped” from the stomach into the intestines too quickly, before it’s been properly digested.

Risks (Short-Term)

• Leaks and infection can occur from where the intestines are re-routed or where part of the stomach is removed.
• A narrowing can occur where the duodenum is connected to the intestine.
• A wound infection can occur in the incision which may require further therapy.
• Pancreatitis or inflammation of the pancreas can occur which can be severe.

Risks (Long-Term)

• Protein malnutrition occurs 3% to 10% of the time which may require hospitalization
• Vitamin, calcium and iron deficiencies can also occur.

This procedure is not reversible.

Please attend one of our Educational Seminars held at NWH, Mt. Kisco to learn more about this and other surgery options.

For questions about our Surgical Weight Loss Program, or
to register to attend a free seminar:

Surgical Weight Loss Program - 877.677.1077