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Dr. Luis A. Betances

Bariatric Surgeon

Biliopancreatic diversion

Biliopancreatic Diversion Procedures: Comprehensive Overview

Biliopancreatic diversion (BPD) is a group of bariatric surgeries designed for effective weight loss and metabolic improvement in individuals with severe obesity. These procedures work by combining restrictive and malabsorptive techniques to limit food intake and nutrient absorption, leading to significant and sustained weight loss. This article covers the three main variations: the classic Biliopancreatic Diversion with Duodenal Switch (BPD-DS), the Duodenal Switch (DS) procedure, and the newer Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy (SADI-S).


1. Biliopancreatic Diversion with Duodenal Switch (BPD-DS)

The BPD-DS is one of the most effective bariatric surgeries for weight loss and metabolic improvement. It is a two-step procedure:

  1. Sleeve Gastrectomy: The stomach is reduced to a tube-like shape, which restricts food intake and reduces hunger by removing the portion of the stomach that produces the hunger hormone ghrelin.
  2. Duodenal Switch: The small intestine is divided and rerouted. The duodenum is connected to the distal ileum, bypassing a significant portion of the small intestine where nutrient absorption occurs.

This combination reduces calorie absorption while preserving the pylorus (the stomach’s natural valve), allowing for better digestion and less risk of dumping syndrome compared to other procedures.

Benefits of BPD-DS

  • Significant and sustained weight loss.
  • High effectiveness in resolving type 2 diabetes, hypertension, and hyperlipidemia.
  • Preservation of the pyloric valve reduces dumping syndrome.

Potential Risks

  • Higher risk of nutritional deficiencies (e.g., protein, fat-soluble vitamins, and minerals).
  • Technically complex and requires experienced surgeons.
  • Longer recovery time compared to less invasive procedures.

2. Duodenal Switch (DS)

The Duodenal Switch procedure is a modified version of the classic BPD-DS. Like the BPD-DS, it combines sleeve gastrectomy with intestinal rerouting but with slightly shorter bypassed intestinal segments to reduce the severity of malabsorption. This modification aims to balance weight loss and the risk of long-term nutritional deficiencies.

Benefits of DS

  • Similar weight loss and metabolic benefits as BPD-DS.
  • Reduced risk of severe malnutrition compared to BPD-DS.
  • High durability for sustained weight loss over decades.

Potential Risks

  • Some risk of nutritional deficiencies remains, requiring lifelong monitoring.
  • May result in gastrointestinal side effects such as frequent bowel movements or foul-smelling stools.

3. Single Anastomosis Duodenal-Ileal Bypass with Sleeve (SADI-S)

SADI-S is a newer variation of the duodenal switch that simplifies the procedure. It involves:

  1. Sleeve Gastrectomy: Creation of a small gastric sleeve to restrict food intake.
  2. Single Anastomosis: The small intestine is rerouted with one connection between the duodenum and ileum, bypassing a significant portion of the small intestine.

This procedure is less complex than the traditional duodenal switch, as it involves only one intestinal connection (anastomosis), reducing operative time and potential surgical risks.

Benefits of SADI-S

  • Simpler surgical technique compared to BPD-DS and DS.
  • Comparable weight loss and diabetes resolution to BPD-DS.
  • Lower risk of surgical complications and internal hernias.
  • Reduced risk of severe nutritional deficiencies compared to traditional duodenal switch.

Potential Risks

  • Requires lifelong vitamin and mineral supplementation.
  • Long-term data are still being collected to confirm durability.

Comparing Advantages of Each Procedure

ProcedureAdvantages
BPD-DSMost effective for weight loss and metabolic improvement; durable long-term results; preserved pyloric valve.
Duodenal Switch (DS)Balances effective weight loss with a reduced risk of severe malnutrition; fewer gastrointestinal side effects.
SADI-SSimplified surgery with similar weight loss and metabolic outcomes; lower complication rate; shorter recovery.

Conclusion

Biliopancreatic diversion procedures, including BPD-DS, DS, and SADI-S, offer highly effective solutions for individuals with severe obesity and metabolic disorders. Each procedure has unique benefits and risks, making them suitable for different patient profiles. While BPD-DS is ideal for maximum weight loss and metabolic improvements, the Duodenal Switch provides a middle ground with fewer nutritional risks. SADI-S stands out for its simplified approach and reduced complications.

Patients considering these procedures should consult experienced bariatric surgeons and a multidisciplinary team to determine the most appropriate option for their needs and long-term health goals.

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Dr. Luis A. Betances, cirujano bariátrico | Medii

Dr. Luis A. Betances

Bariatric Surgeon

Instituto Bariátrico Dr. Luis A. Betances | Medii
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