Overweight and obesity are increasing problems that represent a recognized health burden in the United States and worldwide. Obesity is diagnosed according patients’ Body Mass Index (BMI) and may be difficult to address without the help of a medical team. Patients with a BMI higher than 30 are classified as obese, while higher than 40 as morbidly obese, which in the majority of the cases is not treatable with alterations in dietary and exercise habits alone.
Bariatric or weight loss surgery is usually the last option for patients who tried and failed to lose weight with other methods. Gastric bypass, sleeve gastrectomy, gastric banding and biliopancreatic diversion are the type of procedures currently conducted in the US.
Biliopancreatic Diversion With Duodenal Switch Procedure
Biliopancreatic diversion surgery is designed to alter the normal digestive system, through the shrinking of the stomach. Surgeons reduce the size of the organ and create a bypass for the food to not to pass the first part of the small intestine, which results in an increase of satiety and malabsorption of calories. There are two different types of biliopancreatic diversion. In the more simple procedure, part of the stomach is removed, while the remaining part is attached to the lower portion of the small intestine. The most common surgery is, however, the biliopancreatic diversion with duodenal switch, during which the surgeon removes a different part of the stomach, leaving the valve that controls food drainage from the stomach, the pylorus, intact.
Either of the procedures can be conducted either during open surgery, which is more invasive and has higher risks, or laparoscopically, which means that the surgeon makes small incisions in the abdomen to insert the surgical instruments and a small camera called a laparoscope. With advancements of technology, it is currently more common to undergo a laparoscopic biliopancreatic diversion, since it is less invasive and has lower risks. The procedure is expected to make patients feel full faster and with smaller amounts of food. However, the surgery won’t provoke weight loss alone, and patients need to commit to a healthier lifestyle. The surgery is recommended for patients with a BMI higher than 50, but it also has both advantages and disadvantages for this patient segment as well.
Biliopancreatic Diversion With Duodenal Switch Efficacy and Advantages
Biliopancreatic diversion has been scientifically proven to be successful in helping people achieve and maintain significant weight loss, particularly in patients with “super obesity” — the equivalent to a BMI of 50 or higher. The study “Biliopancreatic Diversion: The Effectiveness of Duodenal Switch and Its Limitations” demonstrates that after two years, patients achieved 73% of excessive weight loss, compared to 63% in the case of gastric bypass, 56% in the case of sleeve gastrectomy and 49% in gastric banding. In addition to weight loss, patients experience as well improvements in their overall health, other associated comorbidities and quality of life.
The study authors explain that, “Biliopancreatic diversion (BPD) produces the most significant weight loss with amelioration of many obesity-related comorbidities compared to other bariatric surgeries; however perioperative morbidity and mortality associated with this surgery are not insignificant; additionally long-term complications including undesirable gastrointestinal side effects and metabolic derangements cannot be ignored. The overall quality of evidence in the literature is low with a lack of randomized control trials, a preponderance of uncontrolled series, and small sample sizes in the studies available. Additionally, when assessing remission of comorbidities, definitions are unclear and variable.”
Biliopancreatic Diversion With Duodenal Switch Disadvantages and Risks
Despite the positive results achieved by patients who undergo biliopancreatic diversion with duodenal switch, it is a difficult and risky procedure conducted only when there are no other viable options. Patients can develop long-term health problems as a result of the surgery itself, since conducting such a procedure in patients with extreme obesity entails risks. After the surgery, patients are required to take vitamin and mineral supplements for the rest of their lives, which can be expensive and require committed patient compliance.
Risks associated with any surgery include incision infections, a leak from the stomach into the abdominal cavity or into the intestinal connection, peritonitis, blood clots in the legs or lungs, gallstones, nutritional deficiency, anemia and osteoporosis. Additional risks specific to biliopancreatic diversion include dumping syndrome, which causes nausea, weakness, sweating, faintness, and diarrhea, as well as osteoporosis, bad smelling stools and diarrhea, and poor nutrition.