Laparoscopic Biliopancreatic Diversion with Duodenal Switch (LBPD-DS)

General Information

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.

Laparoscopic Biliopancreatic Diversion with Duodenal Switch

Laparoscopic Biliopancreatic Diversion with Duodenal Switch – Facts

Duration of surgery

  • between 2.5 and 4 hours

Anaesthesia

  • general anaesthesia

Hospitalisation

  • 4-7 days

Indications for BPD-DS

  • BMI over 50
  • Treatment of:
    • diabetes mellitus type 2
    • arterial hypertension
    • hyperlipoproteinemia
    • 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

Typical LBPD-DS Patient

  • Patient with BMI over 50
  • Patient who accepts obligatory supplementation of vitamins and minerals
  • sweet eaters
  • binge (volume) eaters
  • stress eaters
  • patient with heartburn

Advantages

  • 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

 

Disadvantages

  • 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
  • Diarrhoea
  • Malabsoption (Short Intestine Syndrome)

Operation Time

  • The BPD procedure takes between 2.5 and 4 hours.

Technical description 

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.

Hospitalisation Time

  • The procedure requires a 4-to-7-night stay in the hospital after the operation.

After Surgery

After surgery, the patient must follow special diets and vitamin intake to lose weight in a controlled manner.

Lab Tests:

  • Morphology1
  • Electrolytes1
  • Ferrum1
  • Creatinin
  • Liver ferments1
  • Vitamins B1, B12-level1
  • HDL, LDL, VLDL, Chol2.
  • Ferritin2,3
  • Transferrin2,3
  • Zink2,3
  • Magnesium2
  • 1,25-Dihydroxy-Vitamin D3, Vitamin A2,3
  • Haemoglobin A1c2
  • Parathormon2,3
  • Parathormon - Related Protein2

1. 1 Mo, 3 Mo, 6 Mo, yearly
2. 6 Mo, 1 year
3. yearly

Supplementation:

  • Calcium with Vit D3
 2000mg (with 130ug) per Day
  • Multivit+minerals
 1 tab. per Day
  • Fe+2 Eissen
 1 tab per Day 30mg – one week long in a month, (3 weeks without the Ferrum)
  • Proteins
 70-90g per Day
  • Vit. B12
 every 3 Months i.m. (1000ug) or 25000 I.U. sublingual 2 time a week
  • Vit A
 1 tab. 1mg per Day
  • Vit B1
 1 tab. 2.5mg per Day
  • Zinkum
 1 tab.15 mg per Day
  • Biotin, Selenium, Vitamin B9 (B11)
 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

Diet after BPD-DS

see: Diet after Biliopancreatic Diversion (BPD) with or without Duodenal Switch (DS)