BPD

I posted this on the BPD, thought I was on the DS board so will try again.

I was reading a current article and it gave some states in it stating the RNY corrected Diabetes in 75% of cases and the Biliopancreatic Diversion corrected Diabetes in 95% of the cases.

I had the lap band and did good with portion control. NOT with the band. I am looking to revise to a VSG. My Shrink at the Psych Eval is trying to force me into a RNY due to Diabetes in the family. I do believe the band saved me so far as I was borderline and so was my Sister (18 months older than me.) She is now a Diabetic, I'm normal. If I wanted to convert to a RNY I would have done that 2 years ago When the PCP wanted the band removed. I didn't want them to mess up my stomach/P valve. Which the band did anyway so much for less invasive.

So I am trying do my research so I know what I'm talking about when I talk to the surgeon on the 7th. My question; are they talking about the DS or the Scopinaro procedure? I have been told in no uncertain terms this will be the last surgery I will ever get as I am already fighting against the once in a lifetime WLS rule. My oldest sister has the DS and is the one that stopped me from the RNY in the first place 4 years ago.

By Victoria Stagg Elliott, amednews staff. Posted April 23, 2012.

Most recently, a paper in the March 26 New England Journal of Medicine compared patients with diabetes receiving bariatric surgery with those who got medical treatment for excess weight. After two years, 75% of those *****ceived gastric bypass, and 95% getting biliopancreatic diversion, achieved glycemic control. All the patients in the medical treatment group did not.

This does get confusing. It's unfortunate that the DS is often called the BPD-DS.

I haven't read the specific article you mentioned, so I'll just cover the difference between the BPD and what I will call the DS to avoid confution.

The BPD involves removing the lower half or so of the stoma*****luding the pyloric valve, then dividing the small intestine, attaching the alimentary limb of the small intestine directly to what's left of the stomach, and forming a very short common channel, like maybe 50 cm. This operation worked well for weight loss, but created a lot of problems with nutritional deficiencies and diarrhea. It has been almost completely abandoned in this country.

The DS is a more modern operation in which a sleeve stomach is created with preservation of the pyloric valve. The duodenum is divided, the small intestine is divided maybe half way along, and the alimentary limb is attached to the duodenum, not to the stomach. The common channel is then created, in most cases about 100 cm in length, though there is a lot of variation among different surgeons. But definitely not as short as in the old BPD.

The modern day DS avoids the diarrhea and nutritional problems of the old BPD while still providing great weight loss. It also has the highest rate of resolution of type 2 diabetes of any wls - up to 98%. It used to be thought that RNY resolved diabetes is over 80% of people, but what we are now seeing is that for a good number of those people, the diabetes comes back after a few years. This is rarely, if ever, seen with the DS. The DS has the highest percentage excess weight loss of any bariatric operation presently available, the best maintainence of that weight loss, and the best rate of resolution of almost all comorbidities.

    I understand the concern about the shrink regarding your risk of developing diabetes someday, but his or her info is either out of date or incomplete or both. The DS is your best bet for the diabetes, not RNY. There is a recent study, I believe from the Cleveland Clinic, which compared resolution of diabetes with RNY, sleeve, and band, and RNY was the best of the three, wtih band the worst, but unfortunately (and sadly typically) the DS was not included in that study.

    With the DS, you would also avoid lots of nasty side effects of RNY, which I suspect is why you didn't want it in the first place. No dumping, no food getting stuck, you can drink liquids with meals, and you can take NSAIDs if needed.

    If you want some great articles from the medical literature documenting the excellent longterm results of the DS, not just for weight loss but also for maintainence of good nutritional health, send me a pm with your email address. You will be the most well informed patient that surgeon sees in a long time! But beware, if the name you have listed for your surgeon is the one you are seeing, this is someone who, to my knowledge, doesn't do the DS, so you may need to look elsewhere.

Larra

Thank You for such a great reply!  More that I expected.  I PM'd the addy.

"The BPD involves removing the lower half or so of the stoma*****luding the pyloric valve, then dividing the small intestine, attaching the alimentary limb of the small intestine directly to what's left of the stomach, and forming a very short common channel, like maybe 50 cm."

I had the bilopancreatic diversion with the Duodenal Switch (BPD-DS) and have a working pyloric valve. My common channel was 75cm at the time of surgery and have had no issues. Love it!

The reason you have a working pyloric valve is because you have the "with DS" part. See the pics I posted and you'll understand the difference.

Larra, as always, has given some very good information. Here are some pictures to go along with it:

If you really have a Scopinaro BPD, you have a very large pouch, distal RNY. It looks like this:



A true DS (sometimes called a BPD with DS/duodenal switch) looks like this: