What Is Duodenal Switch (DS)?
This hybrid bariatric operation, known as Biliopancreatic Diversion With Duodenal Switch, Distal Gastric Bypass with Duodenal Switch, Sleeve Gastrectomy With Duodenal Switch, or just plain DS, is one of the more recent types of gastric bypass for the treatment of serious clinical obesity. The original DS procedure was not a bariatric operation: it was invented by Tom R. DeMeester, M.D. to treat patients suffering from a condition in which the stomach and esophagus are burned by bile. Then, in 1988, Dr. Douglas Hess combined the DS with the Biliopancreatic Diversion Bypass (BPD) to create an enhanced form of obesity surgery. This DS procedure produces exceptional weight loss results and permits excellent eating compared to other stomach bypass operations, like Roux-en-Y Gastric Bypass. In contrast to BPD, in the Duodenal Switch operation the pyloric valve is kept intact, this helps to minimize some of the adverse health side effects of the original BPD operation.
Surgeons may perform DS using laparoscopic keyhole surgical techniques or via traditional open surgery. Unfortunately, Billiopancreatic Diversion With Duodenal Switch is a more complex bariatric procedure to learn than either Roux-en-Y or Lap-Band. as a result, fewer surgeons perform the DS compared to other obesity surgeries.
How Does Duodenal Switch Work?
Like the Biliopancreatic Diversion, the DS gastric bypass utilizes both restrictive and malabsorptive techniques to produce significant weight reduction. A reduced-size stomach pouch is created, which restricts the quantity of food patients can eat in a single sitting. In addition, the bariatric surgeon makes it more difficult for this reduced amount of food to be absorbed in the gastrointesinal tract. This is achieved through a bypass of the upper small intestine (duodenum and jejunum) where nutrients (and calories) are normally absorbed into the body. Thus, not only is less food consumed, but even this food cannot be digested as normal, resulting in a large amount of food passing through the shortened gut undigested. It is principally this reduction in calorie and nutrient uptake that causes DS patients to lose so much weight.
What Happens During the DS Operation?
First, a tube-shaped stomach pouch is created from the upper (or proximal) part of the original stomach, using gastric staples. The volume of the new stomach pouch is roughly 150 ml. (Compare BPD pouch size of 200 ml, and Roux-en-Y of 30 ml.) The distal part of the original stomach is then removed from the body (gastrectomy). This makes this type of gastric resection anatomically irreversible. Second, the first part of the small intestine (duodenum) is divided just beyond the stomach to form a proximal biliopancreatic channel (carrying bile, pancreatic and other digestive juices) and a distal food channel (carrying food from the stomach). The food channel takes food from the stomach to the lower (distal) part of the small intestine. The biliopancreatic channel joins the food channel, forming a common channel approximately 50-75 cm from the ileocecal valve leading to the colon (large intestine). This procedure may be modified to suit the individual requirements of the patient. For example, super-obese patients who need to lose more weight may be given an even shorter common channel to further reduce calorie absorption in the gastrointestinal tract. While less obese patients may be given a more extended common channel to permit greater food digestion.
What Is The Main Health Benefit Of Duodenal Switch?
The main advantage of DS bariatric surgery is a high rate of weight reduction in most patients. DS patients typically lose 60-80 percent of their initial excess weight (above ideal weight), compared to 50-75 percent for Roux-en-Y gastric bypass and 40-60 percent for Lap-Band patients. In addition, the pylorus (pyloric valve) remains intact, permitting the flow of gastric juices and keeping dumping syndrome from occurring after surgery. This leads to a huge reduction in side effects such as stomal ulcer and dumping syndrome. Lastly, since the new stomach pouch is larger than is usual after other bariatric operations like Lap-Band, Gastroplasty or Roux-en-Y gastric bypass, DS patients can eat larger portions.
What Is The Main Health Problem Associated With Duodenal Switch?
The principal health danger of DS stomach bypass is nutritional deficiency caused by the reduction in the functional length of the small intestine, where most nutrients are digested and absorbed into the body. As a result, lifelong nutritional supplementation is recommended for all DS patients. That said, Duodenal Switch provides better absorption of many nutrients than does BPD alone, including calcium, iron and vitamin B12.
Is DS Bypass A Dangerous operation?
Yes. A Billiopancreatic Diversion With Duodenal Switch bypass carries all the normal health risks of any major surgical procedure, including perioperative and post-operative health dangers. There is a small risk of death, (less than 1 percent) plus a 1 in 3 chance of a significant post-operative health complication. Specific side-effects from Duodenal Switch include gastric staple breakage, greater chance of chronic diarrhea, more foul smelling stools and flatulence, but less than with the BPD alone.
Who Can Qualify For Duodenal Switch Bypass Surgery?
To qualify for DS obesity surgery, especially as regards medical insurance cover, obese candidates must meet the following criteria:
Degree Of Obesity
DS patients must have a body mass index (BMI) of 40+, or BMI 35+ with added weight-related health problems such as heart disease, sleep apnea, or severe mobility problems.
History Of Failed Weight Loss Attempts
DS candidates must demonstrate a history of failed attempts to reduce body fat using regular weight loss programs, like Weight Watchers, or other diets.
Additional Screening For Obesity Surgery
Obesity centers commonly operate a screening procedure for all candidates for DS bariatricsurgery, to weed out patients who do not have the required commitment to maintain healthy eating and exercise habits after their operation.