Duodenal switch

Bold textThe Duodenal Switch (also known as Bilio-Pancreatic Diversion with Duodenal Switch) procedure is a weight loss surgerythat alters the gastrointestinal tract with two approaches: a restrictive aspect and a malabsorptive aspect.

The restrictive portion of the surgery reduces the stomach along the greater curvature so that the volume is approximately one third to one fifth of the original capacity. The malabsorptive portion of the surgery reroutes a lengthy portion of the small intestine, creating two separate pathways and one common pathway. The shorter of the two pathways, the digestive loop, takes food from the stomach to the large intestine. The much longer pathway, the bilio-pancreatic loop, carries bile from the liver to the common path. The common path is a stretch of small intestine, approximately 75-100 centimeters long, in which the contents of the digestive path mix with the bile from the bilio-pancreatic loop before emptying into the large intestine. The objective of this arrangement is to reduce the amount of time the body has to capture calories from food in the small intestine and to selectively limit the absorption of fat.

Advantages

The primary advantage of the Duodenal Switch (DS) surgery is that its combination of moderate intake restriction with substantial calorie malabsorption results in a very high percentage of excess weight loss for severely obese individuals, with a very low risk of significant weight regain.

Because the pyloric valve between the stomach and small intestine is preserved, people who have undergone the DS do not experience the dumping syndromecommon with people who've undergone the Roux-en-Y gastric bypass surgery.

Those who undergo the DS often find that comorbidities such as (high blood pressure), diabetes mellitus type 2, and arthritisare significantly relieved in a short time after the surgery.

Some surgeons are so confident in the benefits of the DS that they will accept super-morbidly obese patients, who are often turned down for other weight loss surgeries.

Disadvantages

The malabsorptive element of the DS is so potent that those who undergo the procedure must take vitamin and mineral supplements above and beyond that of the normal population. Those that do not run the risk of deficiency diseases such as anemia and osteoporosis.

Because gallstones are a common complication rapid weight loss following any type of weight loss surgery, some surgeons may remove the gall bladder as a preventative measure during the DS. Others prefer to prescribe medication to reduce the risk of post-operative gallstones.

Far fewer surgeons perform the DS compared to other weight loss surgeries, in part because of the need for long-term nutritional follow-up and monitoring of DS patients.

Qualifications

The National Institutes of Healthstate that if you meet the following guidelines, weight loss surgery may be an appropriate measure for permanent weight loss

• BMIof 40 or over
• BMI of 35 or over with serious obesity-related illnesses such as:
  • Diabetes mellitus type 2
  • Coronary heart disease
  • Sleep apnea
• An understanding of the operation and lifestyle changes necessary following the surgery.

Effectiveness

The following statistics are taken from Pacific Laproscopyand Duodenal Switch Information Zone.

Weight loss:

• 3 months - 29 and 37%
• 6 months - 51 and 55%
• 24 months - 80 and 91%

This article is licensed under the GNU Free Documentation License.
It uses material from the Wikipedia article Duodenal switch.