If you are extremely obese and have tried without success to get your weight under control, your healthcare provider may recommend a bariatric surgical procedure known as biliopancreatic diversion with duodenal switch (BPD/DS). 这通常被称为十二指肠开关. It can help you lose more weight than either the gastric bypass or the sleeve gastrectomy. The surgery has been shown to help reduce obesity and related illnesses. These include heart disease, high blood pressure, and especially type 2 diabetes.

BPD/DS is a complex weight-loss surgery that reduces your ability to absorb calories, 维生素, 和矿物质. You can lose more weight with the duodenal switch than with the gastric bypass or the sleeve gastrectomy. You'll be at higher risk of developing nutritional deficiencies afterward. 其中包括一些如果不治疗可能危及生命的疾病. 在决定是否做手术时, these complications and other surgical risks should be carefully considered along with the benefits.

BPD/DS减肥手术

健康care providers may recommend the BPD/DS to people who are severely obese. These people usually have a body mass index (BMI) of 50 or greater or a BMI of 40 or greater with serious type 2 diabetes and other serious health problems. 这些健康问题包括:

• 2型糖尿病

• 睡眠呼吸暂停

• 心脏病

• 肺部疾病

• 高血压

• 高胆固醇

• 非酒精性脂肪肝

BPD/DS is a complex procedure that tackles weight loss in 3 different ways. 首先，进行袖式胃切除术. 对于这个, a large portion of the stomach is removed with a stapling instrument, 留给你一个狭窄的管道, 或套筒, 从胃的顶部到接近底部. With less stomach to fill, you will feel full more quickly and eat less food and fewer calories. 

The second part of the procedure reroutes food away from the upper part of the small intestine, 哪种是消化的自然途径. This cuts back on how many calories and nutrients your body is able to absorb. The small intestine is divided and a connection is made near the end of the small intestine. 

The third part of the BPD/DS procedure changes the normal way that bile and digestive juices break down food. This cuts back on how many calories you absorb, causing still more weight loss. One end of the small intestine is connected to the duodenum, near the bottom of the stomach. 

开放和. 腹腔镜桶/ DS

BPD/DS可以通过腹腔镜或传统的开放手术来完成. In open surgery, the healthcare provider makes a cut in your belly area. Laparoscopic BPD/DS requires much smaller cuts and it uses small instruments with a lighted camera to perform the surgery. Laparoscopic surgery can help you recover more quickly and may reduce the risk for complications, 比如感染和疝气. Some bariatric surgeons use a laparoscopic surgical robot to help do part of the operation. 

手术的好处

BPD/DS可以大大减轻体重, 超过150磅, because it restricts how much food you can eat and also reduces how many calories you can absorb. 它有助于保持这种减肥效果多年, probably better than either the gastric bypass or the sleeve gastrectomy. 它可以减少你身体吸收的脂肪量. 它还能帮你减肥. If you do eat fatty meals, you may have stomach cramping and loose stools. 它还有助于长期控制糖尿病, 甚至比胃旁路手术或袖式胃切除术还好. 

手术风险

BPD/DS reduces the absorption of essential 维生素 和矿物质 and can result in serious, 长期并发症. People who have BPD/DS may develop anemia, osteoporosis, or kidney stones.

In addition, people who have undergone BPD/DS are at high risk for calcium and iron deficiencies. 这些人缺乏维生素A的风险也很高, D, E, 和K, 脂溶性维生素. 

Although rare, a thiamine deficiency can happen after BPD/DS surgery. 如果不及时治疗，会损害神经系统. 

Up to 18% of people with a BPD/DS surgery also develop some element of protein-energy malnutrition. 当严重的, 这种情况被称为夸希奥尔病, 一种严重的、可能危及生命的营养不良.

如果你做了BPD/DS手术, you will need to take vitamin and mineral supplements and have regular blood testing for the rest of your life. This is done to prevent severe vitamin deficiencies and related complications. 即使你按规定服用补充剂, 你仍然可能出现营养问题，需要治疗.

像任何手术一样，BPD/DS手术也有一定的风险:

• 内出血

• 感染

• 腿部的血块可能会转移到肺部

• 疝

• 死亡

手术后

The American Society for Metabolic and 减肥手术 (ASMBS) recommends that healthcare providers prescribe these daily supplements after BPD/DS减肥手术 to help prevent nutritional deficiencies:

• 从手术后2到4周开始服用维生素A

• 从手术后2到4周开始服用维生素D

• 维生素K，从手术后2到4周开始

• Multivitamin with 200% of the daily values, starting the first day after discharge from the hospital

• 最少18到27毫克的铁, and up to 50 mg to 100 mg a day for menstruating women or adolescents at risk for anemia

• 钙补充剂, 通常为3至4次，每次500毫克至600毫克, starting on the first day after your discharge or within the first month after surgery. 注意:不要同时服用铁补充剂. 等几个小时.

• 维生素B12补充剂含有350微克到500微克. 有些人需要每个月给自己注射B12

• 可选复合b族维生素

• 最多三份含钙丰富的乳制品饮料

The ASMBS also recommends that you eat small but nutritious meals that are high in protein, 还有水果, 蔬菜, 全谷物, 还有-3脂肪酸. 你应该避免高糖食物.

It's important to understand that following a healthy lifestyle is critical to maintaining weight loss after surgery. This includes eating a healthy diet and getting plenty of regular exercise. 这需要一生的投入, with regular visits to your bariatric surgeon or other healthcare provider for periodic lab checks. 十二指肠转换可以导致相当大的体重减轻. It also offers improvement or resolution of many obesity-related medical conditions. But it needs regular follow-up and a commitment to taking the protein, 维生素, 还有你需要的补品.