Biliopancreatic Diversion with Duodenal Switch

There are two components to the biliopancreatic diversion with duodenal switch procedure. First, a large portion of your stomach is removed. The new, smaller stomach is about the size and shape of a banana, which limits the amount of food you can eat at once and helps you feel fuller after smaller meals. Next, the first part of your small intestine is divided just after it leaves the stomach. Then, a loop of small intestine further down is attached to the cut end by the stomach, allowing food to bypass a significant portion of the small intestine. This allows the body to reduce the amount of calories and nutrients the body absorbs.

The duodenal switch works because the newly created stomach pouch is smaller and can only hold a few ounces of food at a time, which translates into fewer calories consumed. There is less digestion of food by the smaller stomach pouch, and the segment of small intestine that would normally absorb calories as well as nutrients no longer has food going through it, so there is less absorption of calories and nutrients. Most importantly, the rerouting of the digestive process produces changes in gut hormones that promote satiety, suppress hunger, and reverse one of the primary mechanisms by which obesity induces type 2 diabetes.

Duodenal Switch surgery can be performed as a laparoscopic or robotic (minimally invasive) procedure which involves the use of a small telescope-like camera inserted through a small incision made in the abdomen, or as an open procedure where a large midline incision is made in the abdomen. The robotic method is the most commonly used by Dr Swift in Baltimore, Maryland.

• Low mortality rate (0.2%)
• Weight loss of 80-90% of pre-operative excess weight within one year
• Overall improved health
• Highest rates of resolution or elimination of co-morbidities such as type II diabetes, sleep apnea, hypertension and many others

• Disruption of the staple line can lead to leakage or serious infection
• Possible malnutrition or anemia
• Possible obstruction of the GI tract
• Possible frequent diarrhea and malodorous gas
• Risk of dumping syndrome
• Requires strict adherence to dietary recommendations, life-long vitamin/mineral supplementation, and follow-up compliance

Morbidly obese patients prior to bariatric surgery suffer from a higher frequency of reflux symptoms compared to the general population. To minimize the risk of significant GERD after bariatric surgery we actively screen patients for symptoms of reflux and hiatal hernia.

If detected, we repair it at the time of the bariatric procedure. This approach minimizes risk of possible delayed surgery for this condition which might be needed in about 20% of patients and greatly improve their quality of life after bariatric surgery

Morbidly obese patients are known to have a higher frequency of Gallbladder disease both prior to and after bariatric surgery compared to the general population. Asymptomatic gall stones can cause acute inflammation with significant weight loss after bariatric surgery in 30-40% of patients. It is our policy to actively screen patients for gall bladder problems prior to surgery and if anything is detected (gall-stones, chronic cholecystitis due to dyskinesia, cholesterol polyps), removal of the gall bladder would be recommended at the time of main bariatric procedure. Consequently, the risk of repeat surgery for gall bladder surgery, later on, is avoided. If no problems with the gall bladder are detected after bariatric surgery patients are treated with Ursodiol or Actigall for the first six months after bariatric surgery to prevent problems with the gall bladder.