Bariatric Surgeon Dr. Hossein Bagshahi: Bagshahi Bariatric and General Surgery

Duodenal Switch Procedures

What is Duodenal Switch Weight Loss Surgery?  

Numerous weight loss treatments and surgeries exist, and not all options are right for all patients. The duodenal switch weight loss procedure is particularly effective for patients with certain conditions including diabetes and high blood cholesterol.

Duodenal switch surgery also offers the best results in terms of excess weight lost, both immediately following surgery and over the long term. The duodenal switch procedure is particularly recommended for those individuals with a BMI of 50 or higher.

How Duodenal Switch Weight Loss Surgery Works

The duodenal switch procedure — also known as biliopancreatic diversion with duodenal switch — is a type of weight loss surgery with two components. The first aims to restrict the amount of food that the patient can take in by removing a significant portion of the stomach. The second component aims to prevents full absorption of calories and fat by rerouting and bypassing a significant portion of the small intestine.

Thanks to the combination of food intake restriction and the prevention of calorie absorption, patients undergoing duodenal switch weight loss surgery experience greater weight loss than gastric bypass patients.

The Duodenal Switch Surgery Procedure

The duodenal switch procedure typically takes around four hours. The procedure is performed either laparoscopically or as open surgery, depending on the patient.

First, approximately 70% of the stomach is removed. The remaining stomach becomes cylindrical, linking the esophagus to the duodenum, or the top portion of the small intestine.

The duodenum is then divided into two parts, with one part of the small intestine remaining attached to the stomach. A portion of the small intestine is cut, and the distal small intestine (the part closest to the colon) is attached directly to the duodenum.

By doing so, the patient’s food intake will flow directly from the stomach into the colon, bypassing three-quarters of the small intestine and limiting caloric absorption.

Because such a significant portion of the small intestine is bypassed, food intake is not mixed with pancreatic enzymes and bile until it is close to the colon. This delayed mixing results in a reduced absorption of calories and fat.

Similar to the other surgeries described above, the BPD/DS initially helps to reduce the amount of food that is consumed; however, over time this effect lessens and patients are able to eventually consume near “normal” amounts of food. Unlike the other procedures, there is a significant amount of small bowel that is bypassed by the food stream.

Additionally, the food does not mix with the bile and pancreatic enzymes until very far down the small intestine. This results in a significant decrease in the absorption of calories and nutrients (particularly protein and fat) as well as nutrients and vitamins dependent on fat for absorption (fat soluble vitamins and nutrients).

Lastly, the BPD/DS, similar to the gastric bypass and sleeve gastrectomy, affects guts hormones in a manner that impacts hunger and satiety as well as blood sugar control. The BPD/DS is considered to be the most effective surgery for the treatment of diabetes among those that are described here.

Advantages and Disadvantages

Advantages

1. Results in greater weight loss than RYGB, LSG, or AGB
2. Allows patients to eventually eat near “normal” meals
3. Reduces the absorption of fat by 70 percent or more
4. Causes favorable changes in gut hormones to reduce appetite and improve satiety
5. Is the most effective against diabetes compared to RYGB, LSG, and AGB

Disadvantages

1. Has higher complication rates and risk for mortality than the AGB, LSG, and RYGB
2. Requires a longer hospital stay than the AGB or LSG
3. Has a greater potential to cause protein deficiencies and long-term deficiencies in a number of vitamin and minerals, i.e. iron, calcium, zinc, fat-soluble vitamins such as vitamin D
4. Compliance with follow-up visits and care and strict adherence to dietary and vitamin supplementation guidelines are critical to avoiding serious complications from protein and certain vitamin deficiencies

Recovery from Duodenal Switch Weight Loss Surgery

Duodenal switch patients typically remain in the hospital for a few days after surgery. The hospital monitors patients to ensure that there are no complications from the surgery, such as staple leaks, and to confirm that the rerouted digestive system is functioning correctly.

Most duodenal switch patients have a follow-up appointment with their surgeon a month later, with additional follow-up visits quarterly for the first year and twice a year thereafter. At first, duodenal switch patients are only able to consume a reduced portion of food; over time, the amount of food patients are able to take in will increase, while the resulting lower caloric absorption will remain. In addition, patients are required to follow careful dietary guidelines with a vitamin supplement regime.

Bagshahi Bariatric and General Surgery is pleased to offer their patients the option of duodenal switch weight loss surgery in Fort Worth, TX.

Who Is a Good Candidate for Duodenal Switch Surgery?

Residents of Fort Worth, Texas, and the surrounding area who are contemplating weight-loss surgery must sift through a myriad of important questions, issues and concerns. Chief among them is which surgical procedure best aligns with a person’s physical stature, long-term weight-loss goals, overall health and other personal preferences. When deciding if the duodenal switch (DS) surgery is the right course of action, prospective patients should consider several factors.

Duodenal switch, a modification of biliopancreatic diversion that uses both restrictive and malabsorptive surgical techniques, has a high rate of success, and some professionals even consider it the most effective bariatric surgery. Studies have shown that the procedure also helps address diabetes, elevation of fats in the bloodstream (hyperlipidemia), high blood cholesterol (hypercholesterolemia), high blood triglycerides (hypertriglyceridemia) and sleep apnea, according to the Bariatric Surgery Source.

The surgery is complex and tends to result in a long recovery time – about three to four weeks – but patients can lose between 60 to 80 percent of their excess weight throughout a period of one year to 18 months after the procedure, according to the National Bariatric Link.*

So, how does one know if he or she is a good candidate for this particular weight-loss surgery?

Suitable candidates should have a body mass index (BMI) of more than 40, according to the National Bariatric Link. The surgery tends to be most effective and, therefore, the preferred procedure for people with particularly high BMIs, of higher than 50, or with other metabolic health conditions, such as diabetes. If a candidate has a BMI lower than 40 but wishes to resolve other weight-related medical problems, DS is an option.

The best candidates for DS are between the ages of 18 and 65. However, choosing the appropriate weight-loss method – especially something drastic like a bariatric surgery – comes down to more than one’s BMI.

Those in the Fort Worth area weighing their options for bariatric surgery should take a few other things into consideration before deciding to pursue a DS procedure. For instance, individuals suffering from gastroesophageal reflux disease (GERD) or inflammatory bowel disease (IBD) should speak with a surgeon first, as those conditions may pose a threat.

Additionally, DS patients will rely on dietary and nutrition supplements for the rest of their lives, so they must be sticklers about taking medications exactly as prescribed and following their doctor’s post-surgery guidelines. Not doing so could have severe implications to their health because daily bariatric vitamins, as well as other medications, are necessary to avoid malnutrition and long-term vitamin and mineral deficiencies, according to the Bariatric Surgery Source.

Vegans and vegetarians also should be careful when choosing DS surgery, as they may be particularly at-risk for protein deficiency unless they make sure to get adequate protein from non-meat sources.

Duodenal Switch vs Gastric Sleeve Weight Loss Surgeries

If you are considering bariatric weight loss surgery Fort Worth, TX, exploring the differences between the duodenal switch vs. gastric sleeve procedures will help you become informed regarding your options. The first aspect of the duodenal switch procedure is very similar to the gastric sleeve surgery.

While both are known to produce long term weight losses in severely obese individuals, the duodenal switch surgery produces the largest amount of long term weight loss and is best at treating obesity-related conditions such as diabetes.

Short and long term complications are higher for the duodenal switch when compared to the gastric sleeve procedure, therefore, the latter is often the bariatric surgery of choice for obese people who are not also dealing with a severe illness such as diabetes.

The Gastric Sleeve Procedure Explained

During a gastric sleeve surgery, also known as the laparoscopic sleeve gastrectomy, your surgeon will remove approximately 80% of your stomach and leave behind a tubular pouch that is shaped like a sleeve. The remaining stomach material is stapled together to form your new stomach which will fully heal over time. Unlike the gastric bypass procedure, your pyloric valve (the valve between your stomach and small intestine) is left intact.

Similar to the other surgeries described above, the BPD/DS initially helps to reduce the amount of food that is consumed; however, over time this effect lessens and patients are able to eventually consume near “normal” amounts of food. Unlike the other procedures, there is a significant amount of small bowel that is bypassed by the food stream.

Additionally, the food does not mix with the bile and pancreatic enzymes until very far down the small intestine. This results in a significant decrease in the absorption of calories and nutrients (particularly protein and fat) as well as nutrients and vitamins dependent on fat for absorption (fat soluble vitamins and nutrients).

Lastly, the BPD/DS, similar to the gastric bypass and sleeve gastrectomy, affects guts hormones in a manner that impacts hunger and satiety as well as blood sugar control. The BPD/DS is considered to be the most effective surgery for the treatment of diabetes among those that are described here.

Advantages and Disadvantages of Gastric Sleeve Surgery

Gastric sleeve surgery produces significant long term weight losses ( >50% over 3-5+ years) in the vast majority of people who undergo the procedure.* Hunger is significantly reduced, as the majority of the stomach that produces the hunger hormone ghrelin has been removed.

You will not experience the unpleasant “dumping syndrome” and the risk of nutritional deficiencies is lower than duodenal switch. Gastric sleeve weight loss benefits tend to occur more slowly and are less than the duodenal switch procedure; it is also not the procedure of choice to treat severe diabetes.

Bariatric Surgery Options

Modern advances in bariatric surgery have given patients more options than ever before in meeting their weight loss goals. Determining which procedure is best for you is a process based on your starting weight, height, overall level of health, motivation level and more.

By discussing the pros and cons of each procedure with your Fort Worth, TX based surgeon, you’ll be well on your way to selecting a procedure that can change your life for the better.

The Biliopancreatic Diversion with Duodenal Switch – abbreviated as BPD/DS – is a procedure with two components. First, a smaller, tubular stomach pouch is created by removing a portion of the stomach, very similar to the sleeve gastrectomy. Next, a large portion of the small intestine is bypassed.

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817-250-6210

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