Laparoscopic Biliopancreatic Diversion with Duodenal Switch (LBPD-DS)
Biliopancreatic Diversion with Duodenal Switch is a surgical procedure that can be performed by miniinvasive (Video)surgery. The procedure influences food intake (restriction-sleeve gastrectomy) AND very strongly reduces the absorption of nutrients from the intestinal tract. Absorption of nutrients is limited because a large part of the intestines is bypassed and not used. The food is processed so quickly that there is less time to absorb the nutrients. The volume of the stomach after BPD-DS is between 150 and 250 ml, the active intestinal tract – common channel (where the food and digestive fluids come together) is between 75 and 100 cm long.
The alimentary limb (AL, green in the image) is -DS 150 - 200cm long after BPD, the biliopanceratic limb (BPL, pink in the image) consists of the rest of small intestine.
Indications for BPD-DS
- BMI over 50
- diabetes mellitus type 2
- arterial hypertension
- other related diseases
- Redo surgery after other metabolic operationd in patients with high compliance
- accepts obligatory supplementation of vitamins and minerals
- sweet eaters
- binge (volume) eaters
- stress eaters
- patients with heartburn
Indication for two step procedures:
- BMI over 60 or
- BMI over 50 with high perioperative risks
- very successful (70-90% of excess weight loss)
- Operation for patients in whom restrictive procedures like balloon, banding and sleeve gastrectomies failed
- Operation for volume eaters
- Operation for stress eaters
- Operation for patients with heartburn
- relatively high early complication rate (like dumping syndrome)
- mortality 1 – 2% rate increasing with BMI
- irreversible change in the anatomy
- Life-time vitamins and minerals after surgery
- Foul-smelling flatus Flatulence
- Malabsoption (Short Intestine Syndrome)
- The BPD procedure takes between 2.5 and 4 hours.
Laparoscopic Biliopancreatic Diversion with duodenal switch reduces the size of the stomach through surgical vertical stapling (sleeve gastrectomy). This type of weight loss surgery cuts the stomach and leaves a reservoir of approximately 150 – 250ml in size. Then, two distances are measured: the last 75 to 100cm and 150 to 175 cm of the distal small intestine. The intestine is separated with a stapler machine (GIA) (which sutures and cuts at the same time). Then the intestinal junction is created (called Jejuno-Ileo anastomosis JIA) perfomed with GIA and hand suture between the end BPlimb and the alimentary limb. Afterwards the junction is created between the duodenum, preserving the pyloric muscle and the alimentary limb. The connection directs the food immediately from the stomach to the last 1/3 of the intestines. The first 2/3 of the intestines are now bypassed and are not used anymore for food absorption.
- The procedure requires a 4-to-7-night stay in the hospital after the operation.
After surgery, the patient must follow special diets and vitamin intake to lose weight in a controlled manner.
- Liver ferments1
- Vitamins B1, B12-level1
- HDL, LDL, VLDL, Chol2.
- 1,25-Dihydroxy-Vitamin D3, Vitamin A2,3
- Haemoglobin A1c2
- Parathormon - Related Protein2
1. 1 Mo, 3 Mo, 6 Mo, yearly
2. 6 Mo, 1 year
||2000mg (with 130ug) per Day|
||1 tab. per Day|
||1 tab per Day 30mg – one week long in a month, (3 weeks without the Ferrum)|
||70-90g per Day|
||every 3 Months i.m. (1000ug) or 25000 I.U. sublingual 2 time a week|
||1 tab. 1mg per Day|
||1 tab. 2.5mg per Day|
||1 tab.15 mg per Day|
||Daily for 4 Months|
Bariatric Analysis and Reporting Outcome Score – BAROS
- Once a year
Standard Medication after Operation
- PPI 20mg, 0-0-1 (3 Months)
Sport and physical activity
- Three weeks after operation
- 3 hours of physical activity per week but under sport medical supervision and medical advice