RNY to DS vs. RNY to BPD in plain English is there a difference?

Spoke with 2 well known surgeons concerning my revision. One stated RNY to DS the way to go the other RNY to BPD way to go. Both with excellent reasons. Now I am confused more than ever. Can someone break it down the difference. I have been reading and it sounds like the BPD is the DS which is what one of the surgeons stated. Stated he can use my current pouch and do the switch. Just trying to figure which way to go and who to go with. I have been reading the posts and have learned from everyone so that is why I am asking for help. Thanks for the input.

There is a difference and while I'm not that versed in what it is, I do recall getting the impression that the BPD has a lot more negative side effects and is outdated.  Now it is also possible that the surgeon recommending the BPD is actually referring to the DS and using an outdated term. 

What were some of the differences they mentioned to you?

You do not want the BPD, you want the DS. The BPD keeps the pouch and all it's problems; it's pretty much the same thing as a Distal RNY or ERNY and doesn't have nearly as good results as the full DS. The DS takes down the pouch and reconstructs your stomach then revises it into a VSG or sleeve with fully functional pyloric valve and duodenum. The DS is more difficult and time consuming but well worth the extra effort.

This article was just posted on the same subject:

www.obesityhelp.com/forums/Revision/4083209/Considering-ERNY -revision-May-want-to-look-at-inside-link/  

I got a revision from a 1980 gastric bypass and am thrilled with the results, it's wonderful to have my pyloric valve and duodenum back. No way I would settle for ERNY or BPD.

Kerry

I could be wrong, but I didn't they did the old BPD procedure anymore?  Hopefully someone who has more knowledge will chime in.  They do call the current procedure the DS/BDP, which is totally confusing.

Who were the surgeons?

If I was going to revise from RNY to anything it would be the DS.  I would also make sure that I talked to the big gun revision surgeons - Greenbaum and Rabkin, come to mind - I am sure there are other ones out there that I can't think of now.  I would also make sure that they take down the pouch and give you a fully functioning VSG tummy and do the switch on the intestines.

The top picture is the BPD or Scopinaro procedure, not really the original BPD, Scopinaro said he improved the original BPD.  http://www.keyholesurgerycentre.com.au/pancreaticd.html







































The bottom picture is the Duodenal Switch.  The difference is in the stomach.
The main reason I can see to pick the BPD would be if your remnant stomach is atrophied and your pyloric valve will not re-activate, if that is the case you would really have no choice.  Another reason might be the incidence of leaks when they take down the RNY pouch and re fashion the stomach, then they have to cut the stomach to make the sleeve.

I cannot advise you as I don't know which surgeons you have talked to. I can tell you that I would only have the very best to perform either one of those surgeries.

HTH,
Michele

I am not a medical professional but, these two surgeries are not the same.  The BPD would take the pyloric valve out of the digestive stream.  The pyloric valve is very important.  I know that with the BPD the lower half of the stomach is removed.  I know of one well known surgeon who I have heard is advocating the BPD for revisions.  It is my understanding that is a very bad idea. 

Red

There are some surgeons who are recommending this sort of hybrid operation instead of a true RNY to DS revision. There are any number of names for it, but it boils down to a variant of the ERNY. It's true that it's less risky than a full RNY to DS conversion, which is a very complex operation. However, it preserves the RNY pouch with it's connection to the small intestine. Thus, whatever problems you have with your pouch - dumping, stretched out stoma with insufficient restriction, food getting stuck, whatever - you would still have with this "BPD - like" operation (as one surgeon calls it).
     In addition, you would have malabsorption similar to the DS. While this might promote some weight loss (no one really has longterm statistics for this thing), it would give you the vitamin and protein malabsorption of the DS, but without the fully functional sleeve stomach that we have to get in extra protein and nutrients. AND you would keep the calcium and iron issues of the RNY as the entire duodenum would still be bypassed.

    While a true conversion to the DS would carry more initial risk, I believe it would be superior in the long run both for weight loss and for nutrition.  Also, even though your stomach hasn't been in use for awhile, what I've heard from surgeons who do RNY to DS is that the function gradually returns. In other words, a non-functional sleeve isn't what they are seeing post-op.

    Only you can decide how much risk is acceptable to you.

Please feel free to pm me for more info - Red sent me!

 

Larra

 

 Only a handful of surgeons in the country have the skill to do a full RNY to DS revision (which is really a "conversion" because it's a totally different surgery!  

The BPD is the old version of the DS - it was called the BPD with Duodenal Switch.   It involved making a larger pouch than with the RNY and completely removing the remnant stomach (with the RNY, the remainder of the stomach is left inside the patient).   The common channel was then made somewhat shorter than with the modern DS surgery.   It was pioneered by Dr. Scopinaro in Italy.    It is not done anymore because so many patients had serious vitamin/mineral deficiencies, metabolic and bowel problems.  It is the "grandfather" of the modern DS.

The modern DS involves making the stomach into a "sleeve", not a pouch.   You would not have the stoma of the RNY - your anatomy would be more "natural" because your pyloric valve would be back in charge instead of the "man-made" stoma (these can stretch out).   Also, the greater curvature of your stomach would be completely removed - this is important because this is where the majority of the hunger hormone, Grehlin is produced.  This helps enhance the metabolic effect of the DS surgery.  

The doctor who is suggesting that you leave the  pouch alone and just do the "switch" probably doesn't have the skill to do the entire surgery as a revision (even though he/she might do the virgin DS on a new patient).   You need to find out if this doctor would be removing your blind stomach, thereby making you unable to EVER convert to the full DS (because you won't have enough stomach to cut into a sleeve), or if he/she would be leaving it still in you.    If your blind stomach is still left in you, you would probably have a version of the ERNY (Extended RNY - also sometimes called distal or very long limbed RNY).  If it is removed, you would be left with a form of the old Scopinaro procedure.

From everything I've read on these boards, the full DS revision is more effective in both losing more excess weight and keeping the excess weight off than the ERNY.    The DS also has important differences in the ways the intestines are re-arranged, so that there are less malabsorption problems than with the ERNY.    Dr. Keshishian (one of the DS surgeons) was recently posting on either the DS or revisions board discussing this and answering questions.   

Best of luck with whichever procedure you choose. 

You wrote:

The BPD is the old version of the DS - it was called the BPD with Duodenal Switch.

The surgery being done today and what we call the duodenal switch for short  is many times called the bilipancreatic diversion with duodenal switch (BPD/DS).  The old surgery is called the biliopancreatic diversion (sometimes with Scopinaro method tacked onto the end). 

Red

They are NOT even close, so hike yourself up to Atlanta to see if their DS surgeon's can revise you.  You're likely to get the worst of both worlds with what they're recommending with the old BPD.  The DS is an improvement of the old Scarpinaro BPD that eliminated many of the problems that came with the original proedure.