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Methodist Health System

Biliopancreatic Diversion with Duodenal Switch (BPD/DS) Gastric Bypass

The Biliopancreatic Diversion with Duodenal Switch – abbreviated as BPD/DS – is a procedure with two components. First, a smaller, tubular stomach pouch is created by removing a portion of the stomach, very similar to the sleeve gastrectomy. Next, a large portion of the small intestine is bypassed.

The Procedure

The duodenum, or the first portion of the small intestine, is divided just past the outlet of the stomach. A segment of the distal (last portion) small intestine is then brought up and connected to the outlet of the newly created stomach, so that when the patient eats, the food goes through a newly created tubular stomach pouch and empties directly into the last segment of the small intestine.

The bypassed small intestine, which carries the bile and pancreatic enzymes that are necessary for the breakdown and absorption of protein and fat, is reconnected to the last portion of the small intestine so that they can eventually mix with the food stream. Unlike the other procedures, there is a significant amount of small bowel that is bypassed by the food stream.

Additionally, the food does not mix with the bile and pancreatic enzymes until very far down the small intestine. This results in a significant decrease in the absorption of calories and nutrients (particularly protein and fat) as well as nutrients and vitamins dependent on fat for absorption (fat soluble vitamins and nutrients).

Nutrition Requirements

  • Protein goal 80-100 grams per day
  • An adult multivitamin, containing 100% of the recommended daily allowance (RDA) of at least 2/3 of all nutrients, including 18 mg iron and minerals like zinc and selenium, twice daily
  • 1800 mg to 2400 mg calcium citrate (not calcium carbonate or tricalcium phosphate), divided into three or four doses of about 600 mg each, taken at least two hours apart
  • An additional 18 mg to 27 mg iron for menstruating women
  • 10,000 IU vitamin A (dry form)
  • 2000 IU vitamin D (dry form)
  • 300 mcg vitamin K (dry form)