What is biliopancreatic diversion?

This surgery is done to make your stomach smaller. It also allows food to bypass part of the small intestine. This means you absorb fewer calories and lose weight.

You will be asleep during the surgery. Your surgery will be done in one of two ways. Open surgery is done through a large cut in the belly. This cut is called an incision. Laparoscopic surgery is done through several small incisions. The doctor uses small tools and a camera to guide the surgery.

The doctor will take out part of the stomach but leave the pylorus intact. The pylorus controls food drainage from the stomach. The pylorus is connected to a lower segment of the intestine. The upper part of the small intestine (the duodenum) is then connected to the lower part of the small intestine.

After the surgery, the food you eat will pass from your smaller stomach into the lower part of your small intestine.

The doctor will close the incision in your belly with stitches or staples. These will be removed 7 to 10 days after surgery, unless your doctor uses stitches that dissolve. The incision will leave a scar that fades with time.

Your stomach will be smaller than before. This means that you will get full more quickly when you eat. You will need to change the way you eat.

Your body will have a harder time taking in nutrients. So you will have to take extra vitamins and minerals.

You may stay in the hospital for 1 or more days after the surgery. Most people need 3 to 5 weeks before they can get back to their usual routine.

Before you have this surgery, be sure to discuss the risks and benefits with your doctor.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover.
• Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
• Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or aerobic exercise, until your doctor says it is okay.
• Until your doctor says it is okay, avoid lifting anything that would make you strain. This may include a child, heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, or a vacuum cleaner.
• Hold a pillow over your incision when you cough or take deep breaths. This will support your belly and decrease your pain.
• Do breathing exercises at home as instructed by your doctor. This will help prevent pneumonia.
• Ask your doctor when you can drive again.
• You will probably need to take about 2 to 4 weeks off from work. It depends on the type of work you do and how you feel. You will probably return to normal activities within 3 to 5 weeks.
• You may shower, if your doctor okays it. Pat the incision dry. Do not take a bath for the first 2 weeks, or until your doctor tells you it is okay.
• Ask your doctor when it is okay for you to have sex.

Diet

• Your doctor will give you specific instructions about what to eat after the surgery. For the first 2 to 6 weeks, you will need to follow a liquid or soft diet. Bit by bit, you will be able to add solid foods back into your diet.
• Your doctor may 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.
• At first you may feel full after just a few sips of water or other liquid. 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. Your doctor may suggest fiber, a stool softener, or a mild laxative.
• Sometimes the stomach empties food 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.
  • Avoid high-sugar foods—such as desserts, soda pop, and fruit juices—which are most likely to cause dumping syndrome.
  • Do not drink liquids within a half hour before eating and up to an hour after eating. Liquids move food even more quickly into the small intestine. Quick emptying of the stomach increases the chance of diarrhea.
  • Eat slowly. Try to chew each bite about 20 times. Allow 20 to 30 minutes for each meal.
  • Eat 5 or 6 small meals or snacks a day. This may keep you from feeling too full after eating and may reduce problems with diarrhea and dumping syndrome.
• Check with your doctor before drinking alcohol. Your body may absorb alcohol more quickly after surgery.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You will also be given instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
  • Do not take two or more pain medicines at the same time unless the doctor told you to. Many pain medicines have acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

• If you have strips of tape on the incision, leave the tape on for a week or until it falls off.
• Wash the area daily with warm, soapy water, and pat it dry. Don't use hydrogen peroxide or alcohol, which can slow healing. You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage every day.
• Keep the area clean and dry.

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. 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.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• You may need to follow a clear liquid diet for several days before surgery. Your doctor will tell you how to do this.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

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.

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.

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.

A biliopancreatic diversion with duodenal switch is surgery to make your stomach smaller. This surgery also allows food to bypass part of the small intestine so that you absorb fewer calories and lose weight.

The cut (incision) the doctor made in your belly will probably be sore for several weeks after the surgery. If you have stitches, the doctor will take these out at your follow-up visit.

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 can expect most of your weight loss to happen in the first 12 months after your surgery. You will have regular doctor's appointments during this time to check how you are doing.

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.

It is common to have many different emotions after this surgery. You may feel happy or excited as you begin 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.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no errors.
• You will be kept comfortable and safe by your anesthesia provider. You will be asleep during the surgery.
• The surgery will take several hours.
• If you're having an open surgery, you may get an epidural. This is a tiny tube that puts pain medicine into your back in the area around your spinal cord.

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 are super obese (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.