The Duodenal Switch surgery for weight loss was classified by the National Institutes of Health as ‘extensive gastric bypass with duodenal switch’. Researchers from the University of Chicago found that this surgical procedure for weight loss produces substantially better weight-loss outcomes for super obese patients than the standard operation, the Roux-en-Y gastric bypass.
The ‘Duodenal Switch’, which refers to the re-routing of a section of the small intestine, is just a portion of the actual surgery, however. This gastric bypass surgical procedure is officially known as a biliopancreatic diversion with duodenal switch, and is often referred to by its initials BPD/DS. The BPD/DS is the only bariatric surgery in which a major portion of the stomach is permanently removed. This is the first reason that this operation is often seen as a ‘bigger’ surgery than some of the other types of gastric bypass surgery. The second reason is that a large portion of the small intestine is bypassed.
A considerable section of the small intestine is re-routed, creating three passageways: two separate pathways and one common pathway. The shorter of the two separate passageways carries food from the stomach to the large intestine. The other pathway, which is much longer, is called the bilio-pancreatic loop, because it carries bile from the liver to the common path.
The common path is a portion of small intestine which is usually 75-150 centimeters long. In this channel, the contents of the digestive path mix with the bile from the bilio-pancreatic loop before emptying into the large intestine. The reason these passageways are created and diverted from their normal courses in the body is so that the amount of time the body has to capture calories from food in the small intestine is severely reduced and so that the absorption of fat selectively limited. The duodenum lies just below the stomach and is the first and shortest portion of the small intestine. It is here that most of the chemical digestion takes place in the body.
In this procedure, the shape of the stomach is surgically changed from being the size and shape of a small pineapple to the size and shape of a banana. The pylorus valve at the outlet of the stomach, remains intact, unlike other forms of gastric bypass surgeries. Because of this, patients who have undergone this procedure do not experience ‘dumping’, which makes other weight loss surgery patients feel faint and very ill after ingesting sugar or dense, refined carbohydrates. This surgery is increasing in popularity because it allows the patient to eat larger portions of food than patients of other forms of gastric bypass, while still providing excellent weight loss.
Because such a large portion of the stomach is removed, this operation is irreversible. A section of the small intestine is bypassed and rerouted in this procedure as well, which results in significant calorie and fat malapsorption. This provides the weight loss; however the risks of long term nutritional deficiencies are much greater. Nutritional supplements which are advocated by surgeons for BPD/DS patients are:
Multivitamins (usually twice per day)
Iron supplements (usually twice per day)
Calcium (usually twice per day)
ADEKs (fat-soluble vitamins) usually 3 times per day
Pacific Laproscopy and Duodenal Switch Information Zone gives the following statistics for this type of surgery:
Percentage of Excess Weight Loss Expected:
3 months – 29 and 37%
6 months – 51 and 55%
24 months – 80 and 91%Resolved Medical Co-Morbidities :
97% diabetes resolved
96% high cholesterol resolved
90% sleep apnea resolved
85% hypertension resolved
60% asthma resolved
47% arthritis resolved
The removal of a portion of the stomach in this surgery provides the restrictive component; the patient is just not able to eat as much as he or she could before surgery. The new stomach volume is between one third and one fifth the size of the original stomach. The bypass of the small intestine provides significant malapsorption of the food taken into the body. This surgery is performed by about 50 surgeons worldwide. Of all the bariatric surgery procedures being performed today, this procedure is the most complex. It carries the risk of yielding an unacceptable level of complications in high risk patients, such as those who suffer heart failure and sleep apnea.
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