Biliopancreatic diversion with duodenal switch (BPD/DS) for PCOS

Overview
Biliopancreatic diversion with duodenal switch (also known as the duodenal switch or BPD/DS) is a type of bariatric surgery, or surgery intended to help people lose weight. Duodenal switch surgery is the most complex type of bariatric surgery.

In obese women with polycystic ovary syndrome (PCOS), bariatric surgery may also improve blood glucose control, correct menstruation and hormonal imbalance, and increase fertility. Bariatric surgery may be considered as a treatment for PCOS in women with a body mass index (BMI) above 35. Some surgeons will consider candidates with lower BMIs if they face serious medical complications. Duodenal switch surgery may be considered in women with BMI above 50.

What does it involve?
The goal of bariatric surgery is to shrink the stomach and limit the number of calories you can absorb. Duodenal switch surgery also reroutes the digestive process and limits the effect of digestive juices to further decrease the calories and nutrients absorbed from food.

You will be under general anesthetic for duodenal switch surgery. For duodenal switch surgery, the surgeon may use a traditional wide incision (laparotomy) or make several small, minimally invasive incisions (laparoscopy) to open your abdomen. First, the surgeon will remove a portion of your stomach, making it significantly smaller in a procedure similar to the sleeve gastrectomy. Next, the digestive process is rerouted from the top of the small intestine to near the end. Duodenal switch surgery is not reversible.

Recovery
After duodenal switch surgery, you can expect to stay in the hospital for two to three days. It will take about three to four weeks to recover from the surgery at home before you can return to work and regular activities.

Results
Bariatric surgery has been proven effective for weight loss and improved blood glucose control. Studies have shown that after bariatric surgery, many women of reproductive age experience an improvement in menstrual irregularities and ovulation as well as more balanced hormone levels. There is limited research on fertility after bariatric surgery. In one study following 110 obese women diagnosed with infertility before surgery, 69 participants subsequently became pregnant. More research is needed to clarify the effectiveness of bariatric surgery at reducing the symptoms of PCOS.

Constraints
Any surgery carries risks including blood clots, blood loss, infection, breathing problems, reactions to medication, and heart attack or stroke during the surgery.

Some bariatric procedures can result in malabsorption of nutrients and nutritional deficiencies. Malabsorption can also result in gas, constipation, and diarrhea.

After bariatric surgery, there is a risk for complications such as reflux, incisional hernias, leaks, and bowel obstructions.

If surgery is successful, you will need to change your lifestyle significantly after bariatric surgery. You will need to change what and how much you eat and be sure to get enough exercise. You may need to take nutritional supplements to remain healthy. If you were diabetic, you will still need to check your blood glucose levels regularly. Hyperglycemia (high blood glucose levels) can return after bariatric surgery.

If you lose a lot of weight quickly after bariatric surgery, you may develop significant amounts of loose skin. Some people feel embarrassed about the way the loose skin looks, and some choose to have plastic surgery to remove it.

Depending on your diagnosis and what type of healthcare insurance plan you have, your plan may not cover all or any of the costs of bariatric surgery.

Bariatric surgery is not a cure for PCOS. Your PCOS symptoms may or may not improve after receiving bariatric surgery.

For more details about this treatment, visit:
Defining the role of bariatric surgery in polycystic ovarian syndrome patients – World Journal of Diabetes
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC333...

Bariatric surgery may treat polycystic ovarian syndrome in women of child-bearing age – News-Medical.net
http://www.news-medical.net/news/20110615/Baria...

Bariatric Surgery Procedures - American Society for Metabolic and Bariatric Surgery
https://asmbs.org/patients/bariatric-surgery-pr...

Bariatric Surgery for Type 2 Diabetes Reversal: The Risks – American Diabetes Association
http://care.diabetesjournals.org/content/34/Sup...

Recovery From Bariatric Surgery - University of Rochester Medical Center Rochester, NY
https://www.urmc.rochester.edu/highland/departm...