Bariatric
Surgery: About The Duodenal Switch
The
Duodenal Switch procedure (also called vertical gastrectomy with
duodenal switch, biliopancreatic diversion with duodenal switch, DS
or BPD-DS) is performed by approximately 50 surgeons worldwide. It
generates weight loss by restricting the amount of food that can be
eaten (removal of stomach or vertical gastrectomy) and by limiting
the amount of food that is absorbed into the body (intestinal bypass
or duodenal switch). It is more controversial because it has a
significant component of malabsorption (bypass of the intestinal
tract), which seems to augment and help maintain long-term weight
loss. Of the procedures that are currently performed for the
treatment of obesity, it seems to be the most powerful and effective,
but may also have more complications associated with it. Because of
this, some insurance companies will not authorize it and consider it
investigational. Most surgeons do not perform this procedure because
of concerns about the long term effects of malabsorption.
Duodenal
Switch: How it works
Restriction
(Vertical Gastrectomy): The stomach is restricted by dividing it
vertically and removing more than 85% of it. This part of the
procedure is not reversible. The stomach that remains is shaped like
a banana and measures from 4-7 ounces (120-250cc) depending on the
surgeon performing the procedure. The nerves to the stomach and the
outlet valve (pylorus) remain intact with the idea of preserving the
functions of the stomach while reduing the volume. By comparison, in
a Roux-en-Y gastric bypass, the stomach is divided, not removed, and
the pylorus is excluded. The Roux-en-Y gastric bypass stomach can be
reconnected(reversed) if necessary.
Duodenal
Switch: What is Malabsorption?
Malabsorption
(Duodenal Switch):
The intestines are divided and rearranged to
separate food from the digestive juices, thereby creating
malabsorption. The food limb is attached to the duodenum and receives
food from the stomach. This limb is 150 cm long. The digestive juices
are now separated from the food and travel for over 500 cm in the
bypassed small intestine. Both food and digestive juices mix
together and travel together for 100 cm in the common limb. Thus,
food and digestive juices are separated for most of the length of the
intestines. This prevents you from absorbing all of the calories
that you eat. By comparison, the intestinal bypass in a Roux-en-Y
gastric bypass is much less extensive, and the common limb for
digestive juices and food to mix is approximately 5 times longer.
Therefore, the Roux-en-Y gastric bypass has minimal malabsorption
compared to the Duodenal Switch procedure.
The Advantages of the Duodenal Switch Weight Loss
Surgery Procedure
The
more normal stomach allows for better eating quality but may possibly
result in more diarrhea and foul smelling bowel movements and gas
No
dumping syndrome because the pylorus is preserved
Minimizes
the chance of an ulcer occurring
Very
effective for high BMI patients (BMI>55 kg/m2)
The
intestinal bypass is partially reversible for those having
malabsorptive complications
Laparoscopic
approach is offered by some surgeons
The
Disadvantages of the Duodenal Switch Weight Loss Surgery Procedure
Greater
chance of chronic diarrhea
Significant
malabsorption leads to anemia, protein deficiency and metabolic bone
disease in up to 5% of patients
More
foul smelling stools and gas
Carbohydrates
can be well absorbed and lead to inadequate weight loss
This
procedure is the most complex surgical weight loss procedure and may
yield an unacceptable level of complications in high risk
patients(heart failure, sleep apnea)
Duodenal
Switch: Risks and Complications
As
with any surgery, there can be complications. This list can include:
Deep
vein thrombophlebitis 0.7%
Non-fatal
pulmonary embolus 0.5%
Pneumonia 0.5%
Acute
respiratory distress syndrome 0.25%
Splenectomy 0.9%
Gastric
leak and fistula 2.0%
Duodenal
leak 1.5%
Distal
Roux-en-Y leak 0.25%
Postoperative
bleeding 0.5%
Duodenal
stomal obstruction 0.75%
Small
bowel obstruction 2.0%
Death 1.0%
Laparoscopic
Associates is proud of our lower than average complication rates.
Please view our Weight Loss Surgery results.
Weight-Loss
Surgery Solutions, Duodenal Switch, with Laparoscopic Associates
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Calculator
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