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Duodenal Switch

What is Duodenal Switch?

Duodenal switch, also known as biliopancreatic diversion with duodenal switch, or vertical gastrectomy, is an effective weight loss procedure. This procedure provides long-term weight loss for those people who are severely obese. The duodenal surgery basically limits the amount of food that a stomach can hold and number of calories that can be easily absorbed by the body.

Candidates for Duodenal Switch

  • Insulin-dependent diabetic or poorly controlled diabetic has the highest cure rate with duodenal switch.
  • Candidates who have severe diabetes or has BMI (Body Mass Index) of 60 kg/m2

Duodenal Switch Surgery how it works?

The initial part of this procedure is a sleeve gastrectomy in which the stomach is divided vertically and approximately eighty-five percent is removed. The small sleeve shaped stomach which remains retains the original outlet to the intestines and functions just like a normal stomach. This initial part of the surgery is aimed purely at restricting the quantity of food that can be consumed and this restrictive surgery cannot be reversed.

The second phase of the operation is to make the duodenal switch adding in an element of malabsorption surgery that is largely reversible. Unlike restrictive surgery that causes a loss in weight by physically preventing the patient from eating too great a quantity of food, malabsorption surgery contols the body's power to absorb calories from a meal as it passes through the digestive tract.

During surgery the intestine is divided and a relatively small section (generally approximately 150 cm in length) is used to make a bypass from the duodenum, which is situated near to the outlet of the stomach, to a point near the end of the intestinal tract thereby bypassing the major part of the digestive tract. The consequence of this duodenal switch is that food that passes through the intestinal tract only mixes with the body's digestive juices in the short final section of the intestine below the switch thus allowing the digestive juices very little time to digest the food and absorb calories from it.


Outcomes

  • Approximately 75-80% excess weight loss (EWL) has been reported. (4, 5). (Excess weight is the amount of weight over what is considered the “ideal body weight” for a person’s height [Current Weight – Ideal Weight = Excess Weight]. The percentage of excess weight loss (%EWL) is the percentage of weight loss from this excess weight.)
  • Improvement/resolution in all major co-morbidities has been documented, including type 2 diabetes, sleep apnea, hypertension, high cholesterol and depression. A very high cure rate for diabetes has been reported with this surgery. (6)
  • There is very little risk of “dumping” syndrome—which occurs when a patient consumes sugar or carbohydrates, or eats too quickly, causing nausea, cramping, diarrhea, sweating, vomiting and heart palpitations. Preservation of the pyloric valve provides for a more physiologic emptying of solid foods from the stomach enabling people to tolerate normal foods and reducing dumping syndrome.
  • This is a pill-friendly operation. NSAIDS and Aspirin are well tolerated.
  • Because weight loss is achieved through stomach restriction as well as malabsorption, this surgery is a great option for patients with a high BMI.
  • Benefits of Duodenal Switch

    Some of its benefits include


  • There is average weight loss of about 60-80% excess weight.
  • Duodenal switch results in higher level of patient satisfaction as these patients are able to eat more normal sized meals as compared to other bariatric patients.
  • This procedure helps in achieving long-lasting and significant weight loss because of malabsorptive component of the procedure.
  • Ghrelin (a hunger hormone) is significantly decreased as there is a removal of a large section of the stomach.
  • Duodenal switch is a very effective weight loss procedure for those patients who have a BMI (Body Mass Index) of 50 or more.
  • Duodenal switch is ideal for those patients who did not received any benefit from other types of bariatric surgery.
  • Pyloric valve is kept intact in order to avoid any incidence of stomal ulcers and dumping syndrome which can happen by gastric bypass surgery.

The Laparoscopic Sleeve Gastrectomy with Duodenal Switch

This procedure is also termed as biliopancreatic diversion with duodenal switch that helps in weight reduction of about 45-55% of excess body weight. This range is much higher as compared to laparoscopic adjustable gastric banding procedures. One of the advantages of sleeve gastrectomy is that it preserves Pyloric Valve which regulates the emptying of the stomach while preserving certain centimeters of the duodenum. This procedure is performed laparoscopically where a small stomach pouch of 120cc size is created with the help of stapling devices. The remaining stomach part is also removed. In this procedure the stomach is simply reduced and the gastrointestinal tract is not changed.

This procedure effectively limits the food intake that provides for maximum weight loss. A sleeve gastrectomy patient will now be able to eat a cup of food in three times a day and will feel more full and satisfied after eating small amount of food. A patient will now be able to control his/her cravings and hunger.