Specialists in Biliopancreatic Diversion with a Duodenal Switch
2 Specialists found
Information About the Field of Biliopancreatic Diversion with a Duodenal Switch
What is BPD/DS?
Biliopancreatic diversion with duodenal switch (BPD/DS) is a procedure in which the pathways of the food pulp are significantly altered so that those who are severely overweight can usually reduce weight very effectively. Overweight and obesity is ever-increasing health problem worldwide. Severe obesity causes many secondary diseases such as diabetes, high blood pressure, gallstones, certain cancers, and joint diseases. The life expectancy of obese people is 5-20 years less than ordinary weight people. BPD/DS is a procedure of bariatric surgery, a branch of abdominal surgery. About 1% of bariatric surgery is a biliopancreatic diversion with a duodenal switch.
For Which Patients Is BPD/DS Advisable?
Biliopancreatic diversion is a very invasive and complex method to help patients with morbid obesity (BMI over 40kg/m²) lose weight. This is because, especially in obesity, long-term and adequate weight loss is usually only possible through bariatric surgery. After the failure of conservative therapies (diet, exercise, behavior modification, etc.) and with a BMI over 40kg/m² or a BMI over 35kg/m² with secondary diseases such as diabetes, the methods of bariatric surgery should be considered for the affected person. There is no "gold standard" as to which procedure is best for each patient. An individual decision must always be made for the patient between, for example, biliopancreatic diversion, gastric band, gastric bypass, sleeve gastrectomy, or gastric balloon. The BPD/DS is especially suitable for highly overweight patients (BMI over 50kg/m²) with severe secondary diseases.
How Does Biliopancreatic Diversion Work?
In BPD, the amount of food absorbed is only slightly affected. The main effect of weight loss comes from the influence on the absorption capacity of the intestine. A large part of the intestine is bypassed (diversion = "bypassing"), and food is transported faster through the digestive tract. The digestive tract, through which the food is passed, measures only 50-100cm after the surgery. Therefore, the stomach is reduced in size to about 150-300ml, allowing patients to take in less food until they feel full. In addition, the digestive juices (bile, pancreatic digestive fluid) are late added to the food pulp. As a result, only a fraction of the substances from the food can be absorbed; the majority is excreted in the stool. The diversion procedure can be performed in one or two partial surgeries ("two-stage"). The two-stage approach reduces the mortality risk of this operation from 6% to 1%. It is recommended, especially in BMI over 60kg/m² (the risk increases with BMI) or in cases of generally high surgical risk. In the two-stage method, a tube stomach is formed so that the patient can first lose some weight. Then, the intestinal detour is set up in the second procedure to allow even more effective weight loss. Since rapid weight loss frequently leads to gallstones, the gallbladder is removed prophylactically during this procedure. Diversion should be performed minimally invasively to reduce the risk of complications during surgery (laparoscopically, "keyhole technique"). Patients then suffer less pain, recover more quickly, and are less likely to experience wound healing problems and other complications.
What Are Advantages of Biliopancreatic Diversion?
The method of BPD is very effective in weight reduction and the regression of secondary diseases (such as diabetes, hypertension, long-term mortality). In two years, the operated patients lose on average 70-80% of their excess weight. This makes BPD with duodenal switch the most effective method of bariatric surgery - but also the riskiest. Diversion is suitable for patients in whom gastric balloon, gastric band, or tubular stomach alone have failed. This procedure is also possible in overweight patients with heartburn.
What Are the Disadvantages of BPD?
A significant disadvantage of biliopancreatic diversion is that this procedure results in irreversible changes to the intestine structure. This can lead to diarrhea, bloating, and severe abdominal pain for the person undergoing surgery. Due to the reduced absorption of food components, vital vitamins and trace elements are no longer absorbed and must be supplemented for life to prevent deficiency diseases. During this procedure, patients are at high risk for malnutrition if their diet is incorrect. Patients often develop protein deficiency, anemia, or very foul-smelling fatty stools due to the reduction in digestion, especially of fats.
Since biliopancreatic diversion surgery is technically complicated and has the highest surgical risk among bariatric surgery procedures, it should be considered individually for each patient which method of bariatric surgery is the most appropriate. Accompanying nutritional therapy is strongly recommended for overweight patients, and inclusion in support groups also helps many patients. Patients must have regular follow-up visits to detect malnutrition early.
Which Doctors and Clinics Are Specialized in BPD?
Every patient who needs a doctor wants the best medical care. Therefore, the patient is wondering where to find the best clinic. As this question cannot be answered objectively and a reliable doctor would never claim to be the best one, we can only rely on the doctor's experience.
We will help you find an expert for your condition. All listed doctors and clinics have been reviewed by us for their outstanding specialization in the biliopancreatic diversion with duodenal switch and are awaiting your inquiry or treatment request.
Sources:
Adipositaschirurgie Indikation, Operationsverfahren und Erfolgsaussichten; Thomas P. Hüttl