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EDUCATION6 May 2026

Biliopancreatic Diversion with Duodenal Switch (BPD/DS)

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Duration

2-3 hours

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Downtime

2-4 weeks

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Lasts for

Long-lasting

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Insurance

Can be covered

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Cost

20,000-30,000$

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Setting

Inpatient

Overview

Biliopancreatic diversion with duodenal switch (BPD/DS) combines two approaches to help you lose weight. Your surgeon removes part of your stomach to limit how much you eat, then reroutes your intestines, making them shorter, so your body absorbs fewer calories. This surgery offers significant, long-lasting weight loss and often improves conditions like type 2 diabetes.

Candidates

BPD/DS is recommended it when losing weight is a priority and you can’t commit to a lifelong healthy lifestyle. 

Patients should undergo this procedure if they have: 

A BMI >35 kg/m². 

A BMI lower than that with: 

People with the following conditions should avoid BPD/DS:

How Does it Work?

The procedure includes reshaping the stomach into a narrow tube (like a banana) and reroutes part of the small intestine, where most calorie absorption happens, to connect directly to the new stomach. The bypassed section stays in place to carry digestive fluids from the pancreas to the intestine. 

This promotes weight loss in two ways: the smaller stomach helps feeling full faster, and the rerouted intestine absorbs fewer calories and nutrients from food.

Benefits

Weight loss: ~70% excess weight loss, which is superior to other weight loss surgeries. Buchwald, H., Avidor, Y., Braunwald, E., Jensen, M. D., Pories, W., Fahrbach, K., & Schoelles, K. (2004). Bariatric surgery: A systematic review and meta-analysis. JAMA, 292(14), 1724–1737. https://doi.org/10.1001/jama.292.14.1724

Diabetes type 2 remission: 95% of diabetic people had a complete resolution (the most effective bariatric surgery). Buchwald, H., Estok, R., Fahrbach, K., Banel, D., Jensen, M. D., Pories, W. J., Bantle, J. P., & Sledge, I. (2009). Weight and type 2 diabetes after bariatric surgery: Systematic review and meta-analysis. The American Journal of Medicine, 122(3), 248-256.e5. https://doi.org/10.1016/j.amjmed.2008.09.041

Procedure Types

There are two main versions of this surgery:

Traditional Duodenal Switch (BPD-DS)

  • clock icon2-6 hours

The original technique with two intestinal openings 

This is the more complex approach and takes more time to operate.

Single-Anastomosis Duodenal Switch (SADI-S)

  • clock icon1-2.5 hours

A newer, simplified version with one intestinal opening 

It is a less complex surgery and takes less operative time. Axer, S., Al-Tai, S., Ihle, C., Alwan, M., & Hoffmann, L. (2024). Perioperative Safety and 1-Year Outcomes of Single-Anastomosis Duodeno-Ileal Bypass (SADI) vs. Biliopancreatic Diversion with Duodenal Switch (BPD/DS): A Randomized Clinical Trial. Obesity Surgery, 34(9), 3382–3389. https://doi.org/10.1007/s11695-024-07421-z Verhoeff, K., Mocanu, V., Zalasky, A., Dang, J., Kung, J. Y., Switzer, N. J., Birch, D. W., & Karmali, S. (2022). Evaluation of Metabolic Outcomes Following SADI-S: A Systematic Review and Meta-analysis. Obesity Surgery, 32(4), 1049–1063. https://doi.org/10.1007/s11695-021-05824-w

Both surgeries include a sleeve gastrectomy (making your stomach smaller) combined with rerouting part of your intestines to reduce calorie absorption. And they have comparable outcomes and complication rate. Pereira, A. M., S. Pereira, S., Nora, M., F. Almeida, R., P. Monteiro, M., & Guimarães, M. (2025). Long-Term Outcomes of Single and Dual Anastomosis Duodenal Switch. Obesity Surgery, 35(9), 3791–3800. https://doi.org/10.1007/s11695-025-08114-x

Risks

While BPD-DS produces the greatest weight loss among bariatric procedures, it carries higher complication rates, especially nutritional deficiencies (like vitamins, iron,...). Möller, F., Hedberg, J., Skogar, M., & Sundbom, M. (2023). Long-term Follow-up 15 Years After Duodenal Switch or Gastric Bypass for Super Obesity: A Randomized Controlled Trial. Obesity Surgery, 33(10), 2981–2990. https://doi.org/10.1007/s11695-023-06767-0 Salte, O. B. K., Olbers, T., Risstad, H., Fagerland, M. W., Søvik, T. T., Blom-Høgestøl, I. K., Kristinsson, J. A., Engström, M., & Mala, T. (2024). Ten-Year Outcomes Following Roux-en-Y Gastric Bypass vs Duodenal Switch for High Body Mass Index. JAMA Network Open, 7(6), e2414340. https://doi.org/10.1001/jamanetworkopen.2024.14340

Main complications:

Complication

%

Vitamin D deficiency

57% Nakanishi, H., Abi Mosleh, K., AL-Kordi, M., Marrero, K., Kermansaravi, M., Davis, S. S., Clapp, B., & Ghanem, O. M. (2024). Evaluation of Long-Term Nutrition Outcomes After Duodenal Switch: A Systematic Review and Meta-Analysis. The American SurgeonTM, 90(3), 399–410. https://doi.org/10.1177/00031348231201886

Anemia

31% Nakanishi, H., Abi Mosleh, K., AL-Kordi, M., Marrero, K., Kermansaravi, M., Davis, S. S., Clapp, B., & Ghanem, O. M. (2024). Evaluation of Long-Term Nutrition Outcomes After Duodenal Switch: A Systematic Review and Meta-Analysis. The American SurgeonTM, 90(3), 399–410. https://doi.org/10.1177/00031348231201886

Vitamin A deficiency

25% Nakanishi, H., Abi Mosleh, K., AL-Kordi, M., Marrero, K., Kermansaravi, M., Davis, S. S., Clapp, B., & Ghanem, O. M. (2024). Evaluation of Long-Term Nutrition Outcomes After Duodenal Switch: A Systematic Review and Meta-Analysis. The American SurgeonTM, 90(3), 399–410. https://doi.org/10.1177/00031348231201886

Calcium deficiency

22% Nakanishi, H., Abi Mosleh, K., AL-Kordi, M., Marrero, K., Kermansaravi, M., Davis, S. S., Clapp, B., & Ghanem, O. M. (2024). Evaluation of Long-Term Nutrition Outcomes After Duodenal Switch: A Systematic Review and Meta-Analysis. The American SurgeonTM, 90(3), 399–410. https://doi.org/10.1177/00031348231201886

leak at the surgical connection site

1.14% Chang, S.-H., Freeman, N. L. B., Lee, J. A., Stoll, C. R. T., Calhoun, A. J., Eagon, J. C., & Colditz, G. A. (2018). Early major complications after bariatric surgery in the United States, 2003-2014: A systematic review and meta-analysis. Obesity Reviews : An Official Journal of the International Association for the Study of Obesity, 19(4), 529–537. https://doi.org/10.1111/obr.12647

Other surgery-related complications include: postoperative bleeding- infection- swelling. Möller, F., Hedberg, J., Skogar, M., & Sundbom, M. (2023). Long-term Follow-up 15 Years After Duodenal Switch or Gastric Bypass for Super Obesity: A Randomized Controlled Trial. Obesity Surgery, 33(10), 2981–2990. https://doi.org/10.1007/s11695-023-06767-0 Skogar, M. L., & Sundbom, M. (2020). Early complications, long-term adverse events, and quality of life after duodenal switch and gastric bypass in a matched national cohort. Surgery for Obesity and Related Diseases: Official Journal of the American Society for Bariatric Surgery, 16(5), 614–619. https://doi.org/10.1016/j.soard.2020.02.001

Results

Your weight loss timeline will look like this:

First 3 months

Most rapid weight loss period; approximately 30% of excess weight.

6 months after

Continued significant weight loss.

12 months after

 50-75% of excess weight loss expected.

Chapter references

  1. 1
    Eisenberg, D., Shikora, S. A., Aarts, E., Aminian, A., Angrisani, L., Cohen, R. V., Luca, M. D., Faria, S. L., Goodpaster, K. P. S., Haddad, A., Himpens, J. M., Kow, L., Kurian, M., Loi, K., Mahawar, K., Nimeri, A., O’Kane, M., Papasavas, P. K., Ponce, J., … Kothari, S. N. (2022). 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for Metabolic and Bariatric Surgery. Surgery for Obesity and Related Diseases, 18(12), 1345–1356. https://doi.org/10.1016/j.soard.2022.08.013
  2. 2
    Heinberg, L. J., Ashton, K., & Coughlin, J. (2012). Alcohol and bariatric surgery: Review and suggested recommendations for assessment and management. Surgery for Obesity and Related Diseases, 8(3), 357–363. https://doi.org/10.1016/j.soard.2012.01.016
  3. 3
    Ps, C., B, J., S, P., & P, B. (2002). Bariatric surgery for morbid obesity: Why, who, when, how, where, and then what? Cleveland Clinic Journal of Medicine, 69(11). https://doi.org/10.3949/ccjm.69.11.897
  4. 4
    Buchwald, H., Avidor, Y., Braunwald, E., Jensen, M. D., Pories, W., Fahrbach, K., & Schoelles, K. (2004). Bariatric surgery: A systematic review and meta-analysis. JAMA, 292(14), 1724–1737. https://doi.org/10.1001/jama.292.14.1724
  5. 5
    Buchwald, H., Estok, R., Fahrbach, K., Banel, D., Jensen, M. D., Pories, W. J., Bantle, J. P., & Sledge, I. (2009). Weight and type 2 diabetes after bariatric surgery: Systematic review and meta-analysis. The American Journal of Medicine, 122(3), 248-256.e5. https://doi.org/10.1016/j.amjmed.2008.09.041
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