Loop Duodenal Switch Procedure (SIPS)

The Loop duodenal switch procedure, otherwise called SIPS, is a promising bariatric surgical procedure that has created in the course of the most recent couple of years. SIPS is an abbreviation for ‘Stomach Intestinal Pylorus Sparing Surgery’. Introductory investigations propose that it will give more prominent weight reduction than standard gastric bypass or sleeve gastrectomy without increased complications. SIPS are offered to selected patients with full disclosure to enable them to make an informed decision.

How is the Current Version of Loop Different From the Traditional DS?

The traditional procedure, referred to as the biliopancreatic diversion with duodenal switch (BPD-DS) or the gastric reduction duodenal switch (GR-DS) involved bypassing more than 80% of a person’s small intestines. Although this operation has led to significant weight loss, a subset of patients suffered from malnutrition of vitamins and proteins despite supplements. This is due to the fact that, too little small bowel is removed, which limits the ability of patients to absorb vitamins and essential proteins.

However, if you are looking at how to treat Type II diabetes or increase your weight loss potential in the long run, you must be highly committed to perfect compliance by taking plenty of vitamins and proteins every day for the rest of your life. This is crucial to help you absorb proper vitamins and proteins. With this dedication, the SADI (SIPS) operation proved to be safe and very effective.

Before

After

Before

After

The SIPS procedure consists of three steps:

• Creating a sleeve gastrectomy
• Transecting of the upper part of the small intestine (duodenum) directly behind the outlet of the abdomen (pylorus)
• Connect the loop from the lower part of the small intestine (ileum) to that upper part of the small intestine (duodenum) so that the distance between the joint and the lower arm of the small bowel (ileocecal valve) is 300 cm

How SIPS Evolved

SIPS was an altered version of the operation that was developed 30 years ago, officially called the Biliopancreatic Diversion with Duodenal Switch (BPD-DS) and more simply known as the duodenal switch.

The first two steps are the same in both the duodenal switch and SIPS and include:

• Performing a sleeve gastrectomy
• Transecting of the upper part of the small intestine (duodenum) directly behind the outlet of the abdomen (pylorus)

Step 3 involves modification:

SIPS bypasses less small intestine and connects the loop of the small intestine with the duodenum instead of Roux limb.

These modifications should reduce surgical complications, diarrhea and nutritional deficiencies seen in the original duodenal switch, while preserving most of the metabolic benefits and weight loss of the duodenal switch over gastric bypass or gastric sleeve surgery.

Benefits of Duodenal Switch Surgery/SIPS Procedure

• The DS-SIPS procedure offers maximum weight loss that can be maintained over a long-term period.
• Patients can normally eat after a certain time because the stomach capacity is greater than the gastric bypass.
• No dumping syndrome cases after the surgery.

Risks (Short-Term) of Duodenal Switch Surgery/SIPS Procedure

• There are possible chances of leakage and infection from where the intestine is diverting or removing the part of the stomach.
• Narrowing may occur when the duodenum is connected to the intestines.
• Wound infections may appear in the cut, which may require additional treatment.
• Pancreatitis or pancreatic inflammation may occur, which can be serious.

Risks (Long-Term) of Duodenal Switch Surgery/SIPS Procedure

• Protein malnutrition occurs in 3-10% of cases, which may require hospitalization.
• Vitamins, calcium and iron deficiencies may occur.
• A hernia may develop at the incision site that will require further surgery to repair.
• Duodenal Switch Surgery/SIPS procedure is not reversible.

Here are some common questions with answers to those considering the Loop Duodenal Switch procedure:

Who is the Ideal Candidate for This Operation?

The ideal candidate is a person with BMIs of 50 or more who may be suffering from other health problems such as diabetes.

How is this operation different from previous weight loss surgeries?

The Loop Duodenal Switch has the same sleeve used in traditional bariatric surgery, but a bypass is added on to that. This takes into consideration more prominent weight reduction than the sleeve itself, and furthermore brings about preferred body weight reduction than just bypass. The use of both cause less complications after the procedure.

What Can We Expect Right After Surgery?

Loop Duodenal Switch Patients will remain hospitalized for two nights after the surveillance procedure. First day nausea may be experienced.

What are the most common risks?

Bypassing some of the intestines reduces some of the vitamins and nutrients in the body. This can have a negative effect. For example, if the vitamin A level is too low, you can experience night blindness. It is therefore very important for patients to take all their vitamins, especially fat-soluble vitamins – A, D, E, K, to avoid side effects or malnutrition.

What is a Diet Made of After Surgery?

Patients will begin taking liquid diet immediately after returning from the hospital. A week after they left the hospital, they saw them having a meeting. If they are good then they can move to the next stage of nutrition – soft protein. Months after surgery, patients are able to continue their normal diet. They need 80-100 grams of protein per day and need to stay away from juices, sweet drinks, sweets, acid foods and high fat. The postoperative diet is mostly high in protein, low in carbohydrates and low in fat.

What are the Results of the SIPS Procedure?

There is no long-term monitoring of a large number of patients, but the initial combined results of SIPS and SADI-S are very good. The primary outcomes incorporate a review examination of 123 patients with a normal BMI of 49.4 who experienced a SIPS trial between January 2013 and July 2014.

• 72% excess weight lost at one year
• No intestinal obstruction
• just one marginal ulcer
• one Re-operation

To put this into perspective, in a year, a similar group (size of sample and BMI) of obese patients should lose

• 48% of excess weight after gastrectomy
• 55% of excess weight after standard gastric bypass, with expected morbidity from

1. Around 2 bowel obstructions
2. Around 5 marginal ulcers
3. Around 5 re-operations

The questions are: if these excellent results will stay constant over time, it will be reproducible by other units, and if more numbers reflect the same numbers. Other units are also starting to report their experience. The other unit in the United States recently reported the first 100 cases with similar good results.