43845 Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch)

Name of the Procedure:

Gastric Restrictive Procedure with Partial Gastrectomy, Pylorus-Preserving Duodenoileostomy and Ileoileostomy (50 to 100 cm Common Channel) to Limit Absorption (Biliopancreatic Diversion with Duodenal Switch)

Summary

The biliopancreatic diversion with duodenal switch (BPD/DS) is a weight-loss surgery that involves reducing the size of the stomach and re-routing a portion of the small intestine. This limits both food intake and nutrient absorption, aiding significant weight loss.

Purpose

The purpose of this procedure is to treat severe obesity and its related health conditions, such as type 2 diabetes, hypertension, and sleep apnea. The goal is to achieve sustained weight loss and improve or resolve these associated medical conditions.

Indications

• Body Mass Index (BMI) of 40 or higher, or BMI of 35 with severe obesity-related health issues.
• Failure to achieve or sustain weight loss through non-surgical methods.
• Patients who understand and commit to the necessary lifestyle changes post-surgery.

Preparation

• Fasting for at least 8 hours before the procedure.
• Adjustment or cessation of certain medications as advised by the doctor.
• Pre-procedure assessments such as blood tests, ECG, and psychological evaluation.

Procedure Description

1. Anesthesia: The patient is placed under general anesthesia.
2. Stomach Reduction: The surgeon removes a portion of the stomach, creating a smaller, tube-like stomach (sleeve gastrectomy).
3. Small Intestine Re-routing: The small intestine is divided; the end of the intestine connected to the stomach (duodenum) is re-routed to attach further down the small intestine, preserving the pylorus (the valve controlling food exit from the stomach).
4. Duodenoileostomy and Ileoileostomy: The sections of the small intestine are reconnected to create a common channel between 50 to 100 cm, where food and digestive juices mix, limiting absorption.
5. Closure: The surgical sites are closed with sutures or staples.

Duration

The procedure typically takes 3 to 4 hours.

Setting

The surgery is performed in a hospital operating room.

Personnel

• Lead Surgeon
• Surgical Assistants
• Anesthesiologist
• Operating Room Nurses

Risks and Complications

• Common: Infection, bleeding, blood clots, and leaks at the surgical connections.
• Rare: Nutritional deficiencies, bowel obstruction, and chronic diarrhea.
• Management may involve medication, nutritional supplements, or additional surgery.

Benefits

• Significant long-term weight loss.
• Improvement or resolution of obesity-related health conditions.
• Benefits can be noticed within the first year post-surgery.

Recovery

• Hospital stay of 2 to 3 days.
• Gradual dietary progression from liquids to solids over several weeks.
• Avoid strenuous activities for 4 to 6 weeks.
• Regular follow-up appointments and lifelong vitamin/mineral supplementation.

Alternatives

• Gastric bypass surgery
• Sleeve gastrectomy
• Lifestyle changes (diet and exercise)
• Medication for weight loss
• Pros and cons: Less invasive options might offer slower weight loss, while more invasive surgeries may have higher complication rates.

Patient Experience

• During: The patient will be under general anesthesia and will not feel any pain.
• After: Soreness and discomfort managed through pain medication. Adjusting to new dietary habits and lifestyle changes will be crucial for successful recovery and outcome.