BPD/DS Weight-Loss Surgery

If you are extremely obese and have tried without success to get your weight under control, your doctor may recommend a weight-loss surgery known as biliopancreatic diversion with duodenal switch (BPD/DS). The surgery has been shown to help reduce obesity and related illnesses, including heart disease, high blood pressure, and type 2 diabetes. 

BPD/DS is a complex weight-loss surgery that makes it hard to get enough calories, vitamins, and minerals. You'll be at high risk of developing nutritional deficiencies afterward, including some that can be life-threatening if untreated. When deciding whether to have the surgery, these complications and other surgical risks should be carefully considered along with the benefits.

BPD/DS weight-loss surgery

Doctors may recommend the BPD/DS to people who are severely obese, with a body mass index (BMI) of 40 or greater or a BMI of 35 with serious health problems related to their obesity. These health problems include:

• Type 2 diabetes

• Sleep apnea

• Heart disease

• High blood pressure

• High cholesterol

• Nonalcoholic fatty liver disease

BPD/DS is a complex procedure that tackles weight loss in three different ways. First, the surgery takes out a large portion of the stomach to stop you from overeating. With less stomach to fill, you will feel full more quickly and eat less food and fewer calories.

The second part of the procedure reroutes food away from the small intestine, which is the natural path of digestion. This cuts back on how many calories and nutrients your body is able to absorb.

The third part of the BPD/DS procedure changes the normal way that bile and digestive juices break down food. This cuts back on how many calories you absorb, causing still more weight loss.

Open vs. laparoscopic BPD/DS

BPD/DS is done as either laparoscopic or traditional open surgery. In an open surgery, the doctor makes a large cut in your belly area to reach the stomach and intestines. Laparoscopic BPD/DS requires a much smaller cut – typically only about a half-inch long. And it uses tiny tools with a lighted camera to perform the surgery. Laparoscopic surgery can help you recover more quickly and may reduce the risk for complications such as hernias.

People who are quite obese may not be good candidates for laparoscopic BPD/DS. Laparoscopic surgery may also not be appropriate for people who have already had some type of stomach surgery or those with serious medical problems.

Benefits of the procedure

The BPD/DS can cause drastic, significant weight loss because it restricts how much food you can eat and reduces how many calories you can absorb.

Risks of the procedure

BPD/DS reduces the absorption of essential vitamins and minerals and can result in serious, long-term complications. People who have BPD/DS may develop anemia or osteoporosis.

In addition, people who have undergone BPD/DS are at high risk for calcium and iron deficiencies, as well as deficiencies in vitamins A, D, E, and K. 

Although rare, a thiamine deficiency resulting in a condition called beriberi can occur after BPD/DS surgery. Beriberi can permanently damage the nervous system if untreated. 

Up to 18 percent of people with a BPD/DS surgery also develop protein-energy malnutrition. This is better known as kwashiorkor, a severe and potentially life-threatening form of malnutrition.

If you have BPD/DS surgery, you will need to take vitamin and mineral supplements and have extensive blood testing for the rest of your life in order to prevent severe vitamin deficiencies and related complications. Even if you take the supplements as prescribed, you still may develop nutritional problems and require treatment.

Like any surgery, the BPD/DS procedure carries certain risks:

• Internal bleeding

• Infection

• Potentially fatal blood clots that can move to the lungs or heart

• Hernias

• Death

After the procedure

The American Society for Metabolic and Bariatric Surgery (ASMBS) recommends that doctors prescribe these daily supplements after BPD/DS weight-loss surgery to help prevent nutritional deficiencies:

• Vitamin A, starting two to four weeks after surgery

• Vitamin D, starting two to four weeks after surgery

• Vitamin K, starting two to four weeks after surgery

• Multivitamin with 200 percent of the daily values, starting the first day after discharge from the hospital

• Minimum of 18 to 27 mg of iron, and up to 50 to 100 mg a day for menstruating women or adolescents at risk for anemia, starting the first day after discharge

• Calcium supplements, usually taken as several 500 to 600 mg doses, starting on the first day after your discharge or within the first month after surgery. Note: Don't take these at the same time as iron supplements; wait a couple of hours.

• Vitamin B 12 supplements containing 350 to 500 mcg; some people will need to give themselves B 12 injections

• Optional B-complex vitamin

• Up to three servings of calcium-rich dairy beverages

The ASMBS also recommends that you eat small but nutritious meals that are high in protein, along with fruits, vegetables, whole grains, and omega-3 fatty acids. You should avoid meals high in sugar.

It's important to understand that following a healthy lifestyle is critical to maintaining weight loss after surgery. This includes eating a healthy diet and getting plenty of regular exercise. And it requires a lifelong commitment. For these reasons, BPD/DS surgery should not be considered a quick fix to lose weight.