Biliopancreatic diversion with duodenal switch bariatric surgery

Description:

• procedure is similar in notion to a Roux-en-Y bypass, although the stomach pouch is larger and the amount of bowel bypassed is greater
  • volume of the stomach is reduced by resecting the curvature of the stomach. The small bowel is the resected and joined to the duodenum, bypassing the biliopancreatic limb
  • Biliopancreatic diversion (2)
    • one of the most efficient procedures for weight loss
    • generally offered as a 2-stage operation in patients with a BMI of more than 60kg/m2
    • first step creates a gastric pouch - about a quarter of the size of the original stomach. The remainder of the stomach is removed; pouch is then connected to small intestine as with the bypass
      
      
  • Duodenal Switch procedure is a variant of the Biliopancreatic Diversion (2)
    • as with the original Biliopancreatic Diversion, this operation includes dividing the stomach but only the outer margin is removed, leaving a sleeve of stomach with the pylorus (valve between the stomach and intestine) and duodenum at its end
    • duodenum is divided so that pancreatic and bile drainage is bypassed. The near end of the alimentary limb is then attached to the beginning of the duodenum while the common limb is created in the same way as described previously
      
      
  • disadvantages include (2):
    • surgery is more complex (essentially irreversible) and is associated with more operative and postoperative risks
    • obstruction can occur at the sites of formation of modified GI tract
    • will need to take many multivitamin and mineral supplements on a daily basis for life
    • patients mmay develop gallstones (this happens in 60% of cases) due to rapid weight loss
    • flatulence and loose stools may be experienced especially if dietary changes have not been made to low fat, low sugar choices
    • dumping syndrome may occur if a patient eats too much sugar, fat or alcohol, or large amounts of food
      • not considered a health risk, but can be very unpleasant with symptoms including nausea, vomiting, diarrhoea, sweating, faintness, weakness and tachycardia

Impact on nutrition:

• impacts on absorption of protein, fat, calcium, fat soluble vitamin (A, D, E, K) and zinc

Reference:

• North Bristol NHS Trust. Bariatric Surgery (Accessed January 8th 2019).
• Chelsea and Westminister NHS Hospitals Trust. Weight Loss - Surgical Options (Accessed January 8th 2019)
• BOMSS Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery September 2014.