Surgery Overview

A biliopancreatic diversion changes the normal process of digestion by making the stomach smaller. It allows food to bypass part of the small intestine so that you absorb fewer calories. Because of the risks, this surgery is for people who are more than severely obese and who haven't been able to lose weight any other way.

After surgery, you will feel full more quickly than when your stomach was its original size. This reduces the amount of food you will want to eat. Bypassing part of the intestine also means that you will absorb fewer calories. This leads to weight loss. But your best chance of keeping weight off after surgery is by adopting healthy habits, such as healthy eating and regular physical activity.

There are two types of surgeries: a biliopancreatic diversion and a biliopancreatic diversion with duodenal switch. Most surgeons will not perform duodenal switch surgery unless you are super obese (BMI of 50 or higher) and your weight is causing serious health problems.

These procedures can be done by making a large cut in the belly (an open procedure). Or they can be done by making a small cut and using small tools and a camera to guide the surgery (laparoscopy).

Biliopancreatic diversion

In this surgery, part of the stomach is removed. The remaining part of the stomach is connected to the lower portion of the small intestine. This is a high-risk surgery that can cause long-term health problems, because your body will have a harder time absorbing food and nutrients. People who have this surgery must take vitamin and mineral supplements for the rest of their lives. That can be expensive.

Biliopancreatic diversion with duodenal switch

In this surgery, a different part of the stomach is removed and the surgeon leaves the pylorus intact. The pylorus is the valve that controls food drainage from the stomach. This surgery is high-risk and can cause long-term health problems. That's because your body will have a harder time absorbing food and nutrients. People who have this surgery must take vitamin and mineral supplements for the rest of their lives, which can be expensive. Another name for this surgery is duodenal switch.

What To Expect

You will have some belly pain and may need pain medicine for the first week or so after surgery. The cut that the doctor makes (incision) may be tender and sore.

Most people need 2 to 4 weeks before they are ready to get back to their usual routine.

Because the surgery makes your stomach smaller, you will get full sooner when you eat. Food also may empty into the small intestine too quickly. This is called dumping syndrome. It can cause diarrhea and make you feel faint, shaky, and nauseated. It also can make it hard for your body to get enough nutrition. Having a duodenal switch reduces the risk of dumping syndrome.

Your doctor will give you specific instructions about what to eat after the surgery. You'll start with only small amounts of soft foods and liquids. Bit by bit, you will be able to add solid foods back into your diet.

This surgery removes the part of the intestine where many minerals and vitamins are most easily absorbed. Because of this, you may not get enough iron, calcium, magnesium, or vitamins. It's important to make sure you get enough nutrients in your daily meals to prevent vitamin and mineral deficiencies. You may need to work with a dietitian to plan meals. And you may need to take extra vitamin B12.

Depending on how the surgery was done (open or laparoscopic), you'll have to watch your activity during recovery. If you had open surgery, avoid heavy lifting or strenuous exercise while you recover so that your belly can heal. In this case, you will probably be able to return to work or your normal routine in 4 to 6 weeks. If you have laparoscopic surgery, you may recover faster.

Weight loss

You probably will lose weight very quickly in the first few months after surgery. As time goes on, your weight loss will slow down. You will have regular doctor visits to check how you are doing.

Emotions

It's common to have many emotions after this surgery. You may feel happy or excited as you start to lose weight. But you may also feel overwhelmed or frustrated by the changes that you have to make in your diet, activity, and lifestyle. Talk with your doctor if you have concerns or questions.

Think of bariatric surgery as a tool to help you lose weight. It isn't an instant fix. You will still need to eat a healthy diet and get regular exercise. This will help you reach your weight goal and avoid regaining the weight you lose.

What you can eat

Your doctor will give you specific instructions about what to eat after the surgery. For about the first month after surgery, your stomach can only handle small amounts of soft foods and liquids while you are healing. It is important to try to sip water throughout the day to avoid becoming dehydrated. You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements.

Bit by bit, you will be able to add solid foods back into your diet. You must be careful to chew food well and to stop eating when you feel full. This can take some getting used to, because you will feel full after eating much less food than you are used to eating. If you do not chew your food well or do not stop eating soon enough, you may feel discomfort or nausea and may sometimes vomit. If you drink a lot of high-calorie liquid such as soda or fruit juice, you may not lose weight. If you continually overeat, your stomach may stretch. If your stomach stretches, you will not benefit from your surgery.

Your doctor will probably recommend that you work with a dietitian to plan healthy meals that give you enough protein, vitamins, and minerals while you are losing weight. Even with a healthy diet, you probably will need to take vitamin and mineral supplements for the rest of your life.

Why It Is Done

Weight loss surgery is suitable for people who are severely overweight and who have not been able to lose weight with diet, exercise, or medicine.

Most surgeons will not perform duodenal switch surgery unless you have extreme obesity (body mass index (BMI) of 50 or higher) and your weight is causing serious health problems.

It is important to think of this surgery as a tool to help you lose weight. It's not an instant fix. You will still need to eat a healthy diet and get regular exercise. This will help you reach your weight goal and avoid regaining the weight you lose.

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How Well It Works

Biliopancreatic diversion surgeries are effective. For people who have a very high BMI, biliopancreatic diversion with duodenal switch provides greater weight loss than gastric bypass.^{footnote 1} The long-term success is highest in people who are realistic about how much weight they will lose, go to appointments with the medical team, follow the recommended eating plan, and are physically active.

Risks

Here are some risks common to all surgeries for weight loss:

• You could get an infection in the incision.
• You could get a blood clot in your legs (deep vein thrombosis, or DVT) or lung (pulmonary embolism).
• You may not get enough of certain vitamins and minerals. This can lead to problems such as anemia and osteoporosis.
• Some people get gallstones.
• Some people get kidney stones.
• You may gain the weight back a few years after surgery if you don't follow your eating and lifestyle plan.

Other risks from biliopancreatic diversion surgery include:

Dumping syndrome.

This causes nausea, weakness, sweating, faintness, and possibly diarrhea soon after eating. These symptoms get worse if you eat highly refined, high-calorie foods (like sweets). Sometimes you may feel so weak that you have to lie down until the symptoms pass.

Bad smelling stools and diarrhea.

This can occur because of poor absorption of protein, fat, calcium, iron, and vitamins B12, A, D, E, and K.