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BPD/DS Biliopancreatic Diversion and Duodenal Switch

BPD/DS Biliopancreatic Diversion and Duodenal Switch Diagram

Biliopancreatic Diversion (BPD) and Duodenal Switch (DS) – often just referred to as BPD/DS – is the most effective surgical intervention available for the treatment of obesity problems. It is also the most technically demanding and should only be performed by highly experienced surgeons.

As with standard Roux-en-Y gastric bypass surgery, a BPD/DS procedure combines both restriction and hormone changes, but unlike a gastric bypass, Biliopancreatic Diversion / Duodenal Switch surgery has a much stronger malabsorptive element. Whilst the procedure is much less common than any other obesity surgery, it has a number of advantages which, for the heavier patient, make it an option worth considering.

Healthier Weight do not offer BPD / DS at present. Our experienced Patient Care team are available to discuss the weight loss surgery options we offer. 

How a BPD / DS works

The BPD procedure was first performed by Nicola Scopinaro and although it is still performed, it has largely been replaced with the variation known as Bilio-Pancreatic Diversion with Duodenal Switch. The principles are the same with many of the benefits of the BPD but fewer unwanted effects.

Restriction: The main body of the stomach is removed leaving a small pouch giving the restrictive element of the procedure. Then by cutting and re-routing the small intestine, two “limbs” are created. The alimentary limb is joined to the stomach pouch and the biliopancreatic limb is the bypassed section through which digestive juices pass.

Malabsorption of nutrients: Food moves from the small stomach pouch and passes through the alimentary limb largely undigested. It is only when food reaches the common channel where it mixes with digestive juices from the biliopancreatic limb, that absorption of nutrients (and calories) can take place. By shortening the digestion process to between 80-150cm, the body cannot fully absorb all of the calories and nutrients from food, resulting in weight loss. 

Is a BPD for you?

As a general guide, you may be eligible if your BMI is 60kg/m2 or over and after trying other ways to lose weight without success, you know you need a permanent intervention. If you don't feel that you could comply with the lifestyle changes of a gastric band or you suffer with related conditions eg Type 2 diabetes, hypertension, a BPD/DS offers the most effective results with regards to getting weight under control and dramatically reducing the associated health risks.

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Careful long-term follow-up is essential to achieve your weight-loss goals and avoid nutritional and metabolic complications. At Healthier Weight we have a comprehensive BPD/DS aftercare programme, including:     

  • Close support from Senior Bariatric Nurse in immediate post-operative period 

  • Post-operative clinical review with bariatric specialist at 2 weeks  

  • Clinical review with comprehensive blood tests at 6 months 

  • Further clinical reviews at 3, 12, 18 and 24 months

  • 30 Day Surgical Warranty to cover the cost of further surgery if you suffer a complication

  • Emergency Helpline

  • Dietary guide with all you need to know about eating after BPD/DS     

  • Weight to Go nutritional support to implement habits conducive to long-term weight loss   


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Benefits and risks of the BPD/DS

Health benefits

BPD/DS patients experience the greatest, fastest and most durable weight loss of all obesity surgery procedures with patients losing on average 75-80% of their excess weight. Patients experience fewer side effects than with a gastric bypass such as ''dumping syndrome'. In addition to weight loss, the health benefits of BPD/DS surgery can be substantial, resulting in major reductions in various co-morbidities. Some of these are listed below:

  • Type II diabetes: 95% of patients will have complete resolution of their diabetes

  • Hypertension: 85-90% of patients reduce or stop their anti-hypertensive (blood pressure) medication

  • Dyslipidaemia: 90-95% of patients show major improvement or complete resolution of abnormal cholesterol

  • Sleep apnoea: 80-85% of patients discontinue CPAP†. Improved sleeping patterns, snoring and daytime fatigue 

  • Reflux: 95% of patients will experience major and rapid resolution of symptoms  

  • Stress incontinence: The majority of patients experience marked improvement or complete resolution of symptoms    

  • Infertility and PCOS*: 95% of patients experience correction of underlying hormonal problems and restored fertility    

  • Asthma: Patients with asthma see marked improvement in symptoms and a reduction in medication     

  • Liver disease (NASH)¶: 85-90% of patients will have complete resolution of the disease   

  • Back pain and arthritis: Patients experience marked reduction in joint and back pain and increased mobility   

  • Psychological wellbeing: Reduced depressive symptoms and anxiety, improved social interaction and overall quality of life    

† Continuous Positive Airways Pressure     * Polycystic ovarian syndrome     ¶ Non-Alcoholic Steatohepatitis

Risks and side effects

Although there is no doubt that a BPD/DS operation can be both life-transforming and life-saving, the decision to go ahead with surgery is a serious one. You should choose your BPD surgeon with care as this is not a procedure for the general surgeon and should only be carried out by those specially trained in obesity surgery. That's why we only work with the world's finest bariatric surgeons. Operative risks include:

  • Haemorrhage (bleeding)

  • Adverse reactions to anesthesia and/or medication

  • Blood clots (Deep vein thrombosis in the legs / Pulmonary embolus on the lungs)

  • Infection

  • Death

There is a period of intestinal adaptation after surgery, during which there may be frequent loose bowels, excessive bloating, stomach cramps and frequent passing of foul smelling gas. This usually settles within a few months but in some cases may be permanent.

It is possible to develop long-term complications in the years that follow and the most common post-operative problems relate to nutritional deficiency. BPD/DS surgery involves malabsorption of calories and micronutrients, particularly vitamin D, B12, folate, iron and calcium, it can be associated with long-term nutritional deficiencies which may result in anaemia and bone diseases such as osteoporosis. To avoid these nutritional deficiencies and any associated complications, you will be required to take intensive vitamin and mineral supplementation for life. It is also important to have regular blood checks to monitor your vitamin and mineral stores.
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Weight Loss with a BPD/DS

Typically, we expect BPD/DS patients to lose 75-80% of their excess weight over a 2-year period, although the majority of this weight is lost in the first year. Weight loss results for each patient are however different and your results will depend on how well you adapt your lifestyle and eating habits.

An example of expected weight loss:

  • A 5ft 6in person weighing 17st (240lbs / 109kgs) has an ideal weight of about 11st (154lbs / 70kgs)
  • They are carrying excess weight therefore of 240lbs minus 154lbs = 86lbs.
  • 70% of 86lbs is around 60lbs
  • So this person could expect to lose (on average) up to 60lbs (27kgs) which is between 4 and 4½ stones in weight

Because BPD/DS surgery can result in a significantly reduced absorption of key nutrients, it is much more likely to be associated with long term nutritional deficiencies. The most common problems relate to vitamin D, B12, folate, iron and calcium which result in anaemia and bone diseases such as osteoporosis. To guard against nutritional deficiency, you will need to take high concentrations of vitamins and minerals each day for life. It is also important that you have regular blood checks to make sure that your vitamin and mineral stores adequate to your needs. 

If you follow these instructions you will avoid the long-term complications which could otherwise occur. Scientific evidence suggests that the majority of patients who comply with the follow-up requirements, including nutritional recommendations, do very well. Moreover, compared with obese individuals who have not had surgery, BPD/DS patients have a much lower risk of premature death and disability. 

Excess or loose skin following weight loss

Due to the considerable amount of weight that BPD/DS patients typically lose, it's possible that you will experience some excess, loose or saggy skin. This most commonly occurs in the abdominal apron, or trunk area. The amount of excess skin you'll be left with following a BPD/DS operation varies and will depend upon your age and weight before the procedure. Generally, the heavier and older you are, the more likely you are to have extra skin. Younger patients tend not to have as much loose skin due to greater natural skin elasticity.


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*Weight loss surgery results and benefits vary and are different for each individual. As such, Healthier Weight cannot guarantee specific weight loss goals.