DS is a modification of the BPD

The DS is a modification of the BPD. The DS works through an element of gastric restriction as well as malabsorption. The stomach is fashioned into a small tube, preserving the pylorus, transecting the duodenum and connecting the intestine to the duodenum above where digestive juices enter the intestine. Compared to the BPD, the DS leaves a much smaller stomach that creates a feeling of restriction. Anatomically, the main difference between the DS and the BPD is the shape of the stomach – the malabsorptive component is essentially identical to that of the BPD. Instead of cutting the stomach horizontally and removing the lower half (such as with the BPD), the DS cuts the stomach vertically and leaves a tube of stomach resembling a banana that empties into a very short segment of duodenum. The stomach portion of the DS (duodenal switch) surgical procedure reduces the size of the stomach. But, because it DOES retain the pyloric sphincter, it also retains NORMAL STOMACH FUNCTION. Hence:

* no dumping
* no stoma
* no marginal ulcers
* no strictures
* no 'getting something stuck'
* no reason NOT to drink with meals
* no need to chew food to mush
* no food or medication intolerances.

The bilio-pancreatic diversion with duodenal switch allows food to bypass part of the small intestine so that you absorb fewer calories and significantly reduces the absorption of fat. It also restricts the amount of food you may eat. Portions of the stomach is partially removed. The small pouch that remains is connected directly to the final segment of the small intestine, completely bypassing the duodenum and the jejunum which is known as a partial intestinal bypass and NOT a gastric bypass, since you DO have a functional working stomach and your pyloric valve is kept intact. A common channel remains in which bile and pancreatic digestive juices mix prior to entering the large intestine. Weight loss occurs since most of the calories and nutrients are routed into the colon where they are not absorbed. This procedure has 2 components. A limited gastrectomy is when your stomach is decrease from its orginal size to about 1/3 and similar to a banana (the RNY does not have a stomach, but a stoma hence gastric bypass due to pyloric sphincter removed). A smaller yet, portion of an intact stomach pouch and pyloric sphincter results in reduction of food intake while inducing weight loss. The second component of the operation is a construction of a long limb Roux-en-Y with a short common channel. This creates a significant malabsorptive component which acts to maintain weight loss long term. The length of the common channel may be adjusted in lengths from 50-175 cm for malasbsportion to take place. The results of these adjustments in length variant reportedly carries fewer complications and with comparable weight loss. The DS, also known as BPD-DS surgery is unique, since, it is the only current procedure that allows you to eat normal quantities of food and still achieve weight loss.

Food normally moves along the digestive tract, digestive juices and enzymes digest and absorb calories and nutrients. After we chew and swallow our food, it moves down the esophagus to the stomach, where a strong acid continues the digestive process. The stomach can hold about 3 pints of food at one time. When the stomach contents move to the duodenum, the first segment of the small intestine, bile and pancreatic juice speed up digestion. Most of the iron and calcium in the foods we eat is absorbed in the duodenum. The jejunum and ileum, the remaining two segments of the nearly 20 feet of small intestine, complete the absorption of almost all calories and nutrients. The food particles that cannot be digested in the small intestine are stored in the large intestine until eliminated.

BPD-DS alters the digestive process. The surgery causes a combination of restrictive and malabsorptive process. The restrictive limits food intake by creating a narrow passage from the upper part of the stomach into the larger lower part, reducing the amount of food the stomach can hold and slowing the passage of food through the stomach. The malabsorptive do not limit food intake, but instead partially bypass the small intestine from the digestive tract so fewer calories and nutrients are absorbed. The surgery hencefore, creates a Y shaped intestinal tract for the purpose of separating the biliopancreatic secretions from the food for a certain portion of the passage of food down the alimentary limb. This introduces an element of deliberate malabsorption (the bile acids and pancreatic enzymes are needed to solublize and break down fats, complex carbohydrates and protein, in order of decreasing malabsorption) and is for the purpose of enabling and maintaining weight loss by creating malaborption of those calorie sources. Biliopancreatic diversion with duodenal switch are complex surgeries that should only be done by a very experienced surgeon.

The DS was first reported by Dr. Doug Hess in 1986. This type of surgical procedure was declared a beneficial and effective form of bariatric surgery for the treatment of morbid obesity disease by the Federal Government under the Medicare program on February 2006. It was endorsed by the ASBS (American Society of Bariatric Surgeons) back in 2003. Any medical insurance carrier who claims or still calling the DS 'experimental' is not up to date with current approved medical procedures. Another reason may be that they do not have a qualified DS bariatric surgeon listed on their database roster to accept for assignment and approval for medical service render. Hence appeals are set for motion and the medical insurance carrier will have to pay for surgical and bariatric services OUTSIDE their network since they do not provide and lack of it within their network coverage.