WHAT IS DUODENAL SWITCH BILIO-PANCREATIC DIVERTION (BPD-DS) PROCEDURE?

Biliopancreatic Diversion (BPD) was first developed in 1979 by Italian surgeon Dr. Implemented by Scapinaro. Duedonal Switch (DS) or biliopancreatic diversion (BPD) surgery; It is a highly malabsorption and partially restrictive surgery. We can say that it is the most powerful combination of both sleeve gastrectomy and gastric bypass technique.
Duodenal Switch procedure; Obesity is 98%, Type 2 Diabetus Mellistus remission rate is 95-98%, Dyslipidemia remission rate is 90-95%, Hypertension remission rate is between 80-95% and it is the most powerful technique in Metabolic Surgery and especially Metabolic Syndrome that accompanies Morbid Obesity and cannot respond to medical treatments.
(Obesity+Type2Diabetes Mellitus+Hypertension+Dyslipidemia) is the only treatment option for existing patients. However, correct patient selection is very important for Bilio-pancreatic Diversion-Duodenal Switch (BPD-DS).

IS BARIATRIC SURGERY SAFE DURING THE CORONA VIRUS PANDEMIC?

Patients with metabolic disorders like cardiovascular diseases, diabetes and obesity may face a greater risk of infection of COVID-19 and it can also greatly affect the development and prognosis of pneumonia
Studies have also shown that prior bariatric surgery conveys protection against mortality from COVID-19 and that obesity is the biggest risk factor for mortality from COVID-19 infection in adults. Bariatric surgery has been safely performed in patients who made a full recovery from COVID-19 without increased complications due
to cardiovascular, pulmonary, venous thromboembolism, or increased mortality rates.

The following positive results were also reported in the Italian study; Introduction of strict COVID-19
protocols concerning the protection of patients and health-care professionals guaranteed
a safe response of elective BMS in Italy. The safety profile was, also, maintained
during the second wave of outbreak, thus allowing access to a cure for the obese population.

WHO IS APPLIED TO DUODENAL SWITCH BILIO-PANCREATIC DIVERTION (BPD-DS)?

Duodenal Switch-Biliopancreatic Diversion procedure is suitable for the following people;
Patients with BMI>50 and above
Patients with BMI>50 and Type 2 Diabetes Mellitus
Patients with BMI>50 and Metabolic Syndrome
Patients with BMI>50 and Hypertension and/or Dyslipidemia
Patients with BMI>40 and Metabolic Syndrome
Patients with BMI>40 and uncontrolled (medical therapy resistant) Type 2 Diabetes Mellitus
Patients with BMI>40 and Type2DM relapse after sleeve gastrectomy
Patients with BMI>40 and Type2DM relapse after Rny Gastric Bypass.

WHICH SURGEON SHOULD I CHOOSE FOR DUODENAL SWITCH BILIO-PANCREATIC DIVERTION (BPD-DS) SURGERY?

Obesity The most important criterion in Bariatric and Metabolic surgery is the choice of surgeon. Surgeons who have performed a total of 400 or more bariatric surgical procedures according to IFSO criteria are considered "expert surgeons".
Your surgery will be performed by Expert Bariatric Surgery Specialist, Ersun Topal, MD, General Surgeon. He has 9 years of bariatric surgery experience and >1500 cases (sleeve gastrectomy, rny gastric bypass, omega/mini gastric bypass, sadi-s, duodenal switch-biliopancreatic). diversion, revisionally surgery) has extensive experience and is a member of IFSO and Turkish Obesity Surgery Society

HOW IS DUODENAL SWITCH SURGERY DONE?

Your surgery will be performed through 5-6 holes in the abdominal wall with laparoscopic tecnic.

In the first step of the operation, the stomach is reduced in the form of Sleeve Gastrectomy, but its volume is reduced by a tube.(200-250cc)

The outlet of the stomach is closed and its connection with the small intestine is cut (1)

The small intestine of 400-450 cm from the stomach outlet is completely closed for absorption. A new path is made between the exit door of the stomach and the last 150-200 cm of the small intestine (2)

A new route is made between the part of the intestine that brings bile and pancreatic digestive enzymes and the part that brings food from the stomach outlet (3)
Food and digestive enzymes meet in this 3rd pathway and absorption takes place at the distance from the 3rd pathway to the large intestine (150-200cm).

Only the last 150-200 cm of the small intestines of 650-700 cm in total are open to "food absorption", and thus only 20-30% of the calories we take (absorbed from the last 150-200 cm of the intestines) mix into the blood. Thus, since very little of the carbohydrate taken orally mixes into the blood, it can provide up to 98% remission in the treatment of Type 2 Diabetes Mellitus.

IS THE DUODENAL SWITCH PROCEDURE A SAFE PROCEDURE?

It is the most risky bariatric surgery procedure among bariatric surgical techniques. The surgeon's experience and the quality of titanium staples used are very important. Only U.S FDA (Food and Drug Administration; The FDA is responsible for protecting the public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biological products) approved Medtronic Endoscopic Staples is used in our clinic.

Absolutely replica/cheap Chinese brands staples are not used!!

WHY SHOULD I PREFER ISTANBUL BARIATRIC CLINIC?

a-Surgeon's experience (+1500 bariatric and metabolic surgeries)
b-Using FDA approved Medtronic Tri-Staples Tech stapler

WHAT ARE THE RISKS OF THE DUODENAL SWITCH procedure?

In the first 30 days, the rate of re-admission to the hospital is 6%, anastomotic line leaks (0.6-1.2%) mortality rate 1% nausea (2-4%) superficial surgical site infection (2.2%) stenosis in the anastomosis line (1-2.9%), hypoproteinemia 6-15% diarrhea/steatorrhea 20%

WHAT SHOULD I DO BEFORE DUODENAL SWITCH BILIO-PANCREATIC DIVERTION (BPD-DS)?

You should start “healthy eating” from the moment you decide to have the surgery, you should quit alcohol for your liver health, For your lung health, you should quit smoking. You must stop all painkillers (ibuprofene, diclophenac, Naproxen and etc non-steroidal anti-inflammatory drugs) except Paracetamole. You should start to drink 1 of the over-the-counter Proton Pomp Inhibitor drugs (Pantaprasole, Esomeprazole, Lansaprasole ext.) every morning on an empty stomach.

IS CHECK-UP REQUIRED BEFORE DUODENAL SWITCH BILIO-PANCREATIC DIVERTION (BPD-DS) PROCEDURE?

Before obesity surgery, blood tests, chest X-ray, Electro-cardiography, upper gi endoscopy (with and under sedation anesthesia) will be performed. If you have heart disease or diabetes, your consultations will be made.

DO I HAVE TO PAY EXTRA CHARGES FOR CHECK-UP PROCEDURES BEFORE DUODENAL SWITCH BILIO-PANCREATIC DIVERTION (BPD-DS)?

You will not pay extra-charges for the “standard tests and examinations” that must be done before the surgery.

WILL I HAVE PAIN AFTER DUODENAL SWITCH BILIO-PANCREATIC DIVERTION (BPD-DS) SURGERY?

Before your surgery begins, pre-medication will be administered to control analgesia. Also “A patient controlled analgesia (PCA) system allows you to give yourself a dose of intravenous pain medicine, with the push of a button. This system decreases any pain and anxiety you may feel while waiting for medicine.

IS STAPLER QUALITY IMPORTANT IN DUODENAL SWITCH BILIO-PANCREATIC DIVERTION (BPD-DS) SURGERY?

In bariatric and metabolic surgery, the quality of the stapler to be used determines the quality of the surgery. Only Medtronic Tri-Staple Tech original American product is used in our clinic. We definitely do not use the cheaper Chinese made staplers.

HOW WILL I FEED AFTER DUODENAL SWITCH BILIO-PANCREATIC DIVERTION (BPD-DS)?

After your surgery, you will start feeding with foods prepared by your Bariatric Surgery Dietitian in accordance with the “AACE/TOS/ASMBS Guidelines Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient”.

Frequently Asked Questions