Duodenal Switch

Biliopancreatic Diversion with Duodenal Switch (BPD/DS)


The Biliopancreatic Diversion with Duodenal Switch – abbreviated as BPD/DS – is a procedure with two components. First, a smaller, tubular stomach pouch is created by removing a portion of the stomach, very similar to the sleeve gastrectomy. Next, a large portion of the small intestine is bypassed.

The Procedure

The duodenum, or the first portion of the small intestine, is divided just past the outlet of the stomach. A segment of the distal (last portion) small intestine is then brought up and connected to the outlet of the newly created stomach, so that when the patient eats, the food goes through a newly created tubular stomach pouch and empties directly into the last segment of the small intestine. Roughly three-fourths of the small intestine is bypassed by the food stream.

The bypassed small intestine, which carries the bile and pancreatic enzymes that are necessary for the breakdown and absorption of protein and fat, is reconnected to the last portion of the small intestine so that they can eventually mix with the food stream. Similar to the other surgeries described above, the BPD/DS initially helps to reduce the amount of food that is consumed; however, over time this effect lessens and patients are able to eventually consume near “normal” amounts of food. Unlike the other procedures, there is a significant amount of small bowel that is bypassed by the food stream.

Additionally, the food does not mix with the bile and pancreatic enzymes until very far down the small intestine. This results in a significant decrease in the absorption of calories and nutrients (particularly protein and fat) as well as nutrients and vitamins dependent on fat for absorption (fat soluble vitamins and nutrients). Lastly, the BPD/DS, similar to the gastric bypass and sleeve gastrectomy, affects guts hormones in a manner that impacts hunger and satiety as well as blood sugar control. The BPD/DS is considered to be the most effective surgery for the treatment of diabetes among those that are described here.


  1. Results in greater weight loss than RYGB, LSG, or AGB, i.e. 60 – 70% percent excess weight loss or greater, at 5 year follow up
  2. Allows patients to eventually eat near “normal” meals
  3. Reduces the absorption of fat by 70 percent or more
  4. Causes favorable changes in gut hormones to reduce appetite and improve satiety
  5. Is the most effective against diabetes compared to RYGB, LSG, and AGB


  1. Has higher complication rates and risk for mortality than the AGB, LSG, and RYGB
  2. Requires a longer hospital stay than the AGB or LSG
  3. Has a greater potential to cause protein deficiencies and long-term deficiencies in a number of vitamin and minerals, i.e. iron, calcium, zinc, fat-soluble vitamins such as vitamin D
  4. Compliance with follow-up visits and care and strict adherence to dietary and vitamin supplementation guidelines are critical to avoiding serious complications from protein and certain vitamin deficiencies

Biliopancreatic Diversion with Duodenal Switch

BPD/DS is a complex weight loss surgery. It reduces your ability to absorb calories, vitamins, and minerals. This type of bariatric surgery Is more extreme and offers greater weight loss than gastric bypass or gastric sleeve.

Am I A Good Candidate?

duodenal switch marylandTypically, duodenal switch is recommended for people who are severely obese. This generally means a BMI of 50 or more. Or a BMI of 40 or more with a serious obesity-related health condition. This includes:

  • Type 2 diabetes
  • Sleep apnea
  • Lung disease
  • High blood pressure
  • Heart disease
  • Nonalcoholic fatty liver disease
  • High cholesterol

How It Works

Duodenal switch surgery increases weight loss in three major ways. First, the provider removes a large portion of the stomach, leaving behind a narrow tube. With a smaller stomach, you eat less food, feel full quicker and consume less calories.

Next, the second part of the procedure reroutes food away from the upper part of the small intestine. One end of the small intestine is connected to duodenum, near the bottom of the stomach. This further reduces your caloric absorption.

Finally, the procedure also changes the way that bile and digestive juices break down your food. This also helps reduce the calories you consume, contributing to weight loss.

Benefits of Duodenal Switch Surgery

This weight loss procedure can be performed laparoscopically. This means the provider makes a few small cuts in your abdomen and uses small instruments and a camera to perform your surgery. Laparoscopic procedures are less invasive, help you recover more quickly, and also help reduce the risk of complications. Some bariatric surgeons even use robotic tools to help perform the operation.

Another benefit is that duodenal switch offers drastic weight loss. Because this procedure is both restrictive and reroutes the digestive track, it can produce large weight loss. It reduces how much you can eat and also reduces the calories you absorb.

Additionally, it helps you maintain weight loss for many years.

Life After Duodenal Switch

After your surgery, you will have to change the way you eat. After your stomach has healed and you move onto eating solid foods again, you should focus on eating small, nutritious meals. Choose meals that are high in protein, with a variety of fruits, vegetables, whole grains, and omega-3 fatty acids.

You will also need to take certain vitamins daily to prevent a deficiency. Since this procedure greatly reduces the vitamins and minerals you absorb from the food you eat, it’s important to supplement these.

Duodenal Switch Surgery in Maryland

Don’t let your excess weight hold you back anymore. If you are tired of struggling with obesity, it’s time to talk to a bariatric surgeon. The providers at Maryland Bariatrics are ready to help you find the best weight loss surgery for you. In addition to weight loss, you can enjoy improved health, better mental health, and more. Contact us today to learn more!