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Duodenal Switch

Duodenal Switch

Duodenal switch is an increasingly common option reserved for patients with a Body Mass Index of 50 or higher. The surgery is a combination of vertical sleeve gastrectomy and intestinal bypass. It promotes maximum long-term weight loss in three ways:

  • By reducing stomach volume and restricting the amount of food that can be consumed
  • By eliminating the production of Ghrelin, an appetite-stimulating hormone
  • By limiting the amount of calories the body can absorb

Duodenal switch is known as one of the more aggressive weight loss surgery options, generally resulting in greater weight loss and improvements in obesity-related conditions for a number of patients. At the same time, it is associated with a potentially higher rate of complications. Duodenal switch is a technically demanding procedure, and Temple's board-certified surgeons possess the skills and experience to offer the surgery both open and laparoscopically. Depending on a patient's risk profile, duodenal switch can be performed as a single procedure or in two separate stages, performed about a year apart.

During duodenal switch, the stomach is vertically divided and 80 to 85 percent of it is removed. This limits the amount of food than can be eaten per meal while eliminating the production of Ghrelin, a hormone made in the stomach that can stimulate excess appetite. The surgeon leaves the stomach's outlet valve intact to preserve critical functions and prevent the "dumping syndrome" associated with gastric bypass surgery.

The second part of the duodenal switch involves rearranging the intestines so that ingested food does not come into contact with digestive juices until after it has passed through most of the bowels. This prevents the body from absorbing the majority of the calories from food.

Compared to gastric bypass surgery, duodenal switch has been shown to offer significantly more weight loss (about 50 pounds or more) in patients with a BMI of 50 or greater. Duodenal switch is also associated with greater improvements in type 2 diabetes, hypertension and cholesterol in these patients compared to those who underwent gastric bypass.

Because duodenal switch reduces the absorption of calories, it also limits the body's ability to absorb fat-soluble vitamins (A, D, E and K) and proteins. Therefore, all patients who undergo the procedure must take supplements for the rest of their lives to remain in good health. Patients must also undergo periodic blood tests to monitor their nutritional status. Temple's dieticians are available for ongoing education and support as patients move through the preoperative and postoperative process.

The advantages of duodenal switch include, in part:

  • Highly effective in morbidly obese patients (BMI of 50 or higher)
  • Greater weight loss and improvements in comorbid conditions, such as hypertension and type 2 diabetes, when compared to gastric bypass surgery
  • Because the stomach's outlet valve (pylorus) is preserved, most foods can still be consumed, albeit in smaller amounts
  • The removal of the section of the stomach that produces Ghrelin, a hunger-stimulating hormone
  • The elimination of "dumping syndrome" that can occur when fats or sweets are ingested after gastric bypass surgery  

The disadvantages of duodenal switch include, in part:

  • Malabsorption of vitamins and proteins requires patients take supplements and undergo periodic blood tests
  • Noncompliance can lead to protein deficiencies, vitamin deficiencies, anemia and/or metabolic bone disease
  • The possibility of bloating, gas and frequent loose bowel movements

Results very for each person and you consult a physician to determine what procedure is right for you.

To register for a free informational seminar or to make an appointment for a consultation with a Temple bariatric surgeon, click here or call 1-800-Temple-Med (1-800-836-7536).

 

Sources:

Annals of Internal Medicine: //annals.org/article.aspx?articleid=747095

Journal of Gastrointestinal Surgery: //www.ncbi.nlm.nih.gov/pubmed/19937190

American Journal of Clinical Nutrition: //ajcn.nutrition.org/content/90/1/15