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Laparoscopic Biliopancreatic Diversion with Duodenal
Switch
The Biliopancreatic Diversion with Duodenal Switch is both a restrictive
and malabsorptive procedure.
How it works:
The duodenal switch can be performed laparoscopically and is the most extreme
procedure done today for weight loss. It is a more complex surgery and is
usually reserved for those patients with a BMI over 55. (see figure)
The restrictive component involves reducing the size of the stomach. The
surgeon would divide the stomach vertically and remove more than 85 percent of
it. The stomach that remains is shaped like a banana. Duodenal switch surgery
is a variation of another procedure, called biliopancreatic diversion. But the
duodenal switch leaves a larger portion of the stomach intact, including the
pyloric valve, which regulates the release of stomach contents into the small
intestine. As the name suggests, the duodenal switch also keeps a small part of
the duodenum in the digestive system. The duodenum is the first part of the
small intestine. It is located between the stomach and the jejunum, or the middle
part of the small intestine. Unlike the Roux-en-Y gastric by-pass, which
employes a gastric “pouch” and bypasses the pyloric valve, the DS procedure
keeps the pyloric valve intact. This eliminates the possibility of dumping
syndrome, marginal ulcers, stoma closures and blockages, all of which can occur
after other gastric bypass procedures.
Malabsorptive surgeries restrict the amount of calories and nutrients the body
absorbs. The malabsorptive component of duodenal switch surgery involves
rearranging the small intestine to separate the flow of food from the flow of bile
and pancreatic juices. The food and digestive juices interact only in the last 18 to
24 inches of the intestine, allowing for malabsorption. Unlike the restrictive part
of the surgery, the intestinal bypass part of the duodenal switch is partially
reversible if you are one of the people who experience malabsorptive
complications
What to expect after surgery:
Part of the recovery process involves getting re-accustomed to eating solid
foods. People who undergo the duodenal switch can consume only fluids
immediately following surgery. From there, they will progress to pureed foods
and ultimately solids.
Most of the weight loss with the duodenal switch occurs during the first 12 to 18
months after surgery. With this procedure the patient should expect to loose
about 80 to 100% of excess body weight.
The duodenal switch may result in more nutritional deficiencies than other weight
loss surgeries because of the malabsorption it causes. As a result, the patient will
need to take nutritional supplements, including vitamin A, vitamin D and calcium,
daily for the rest of his/her life. Some doctors may also recommend additional
supplements of potassium and iron. Lifelong nutritional follow-up is needed after
duodenal switch.
There are other nutritional considerations after undergoing duodenal switch. For
example, eating fatty foods tends to cause foul-smelling gas and diarrhea. In
addition, some very starchy foods may cause gassiness. Note that everyone
responds differently to different foods, so every patients experience varies.
All surgeries have short- and long-term risks. The short-term risks of
duodenal switch include:
Bleeding/blood loss
Blood clots
Infection
Leakage. A leak means that a perforation of the stomach or a leak from
anywhere the bowel is stitched together has occurred.
The long-term risks of duodenal switch include:
Nutritional deficiencies
The brittle bone disease osteoporosis, due to malabsorption of calcium and
vitamin D, which are needed to maintain bone strength
Night blindness due to malabosption of Vitamin A
Malabsorption of protein, leading to malnutrition. This may lead to a second
operation.
Carbs can be well absorbed, resulting in inadequate weight loss
Chronic diarrhea. Patients may have many loose bowel movements in a day.
In the duodenal switch, the surgeon shortens the amount of bowel that the
food goes through and diverts the digestive juices. The food goes through
half of the intestines and then does not meet the digestive juices until the
tail end of the intestines. This cripples the digestive process, resulting in
diarrhea.
Foul-smelling stools and gas
Compared with other types of weight loss surgery, the duodenal switch has
these advantages:
The remaining stomach is much larger after duodenal switch surgery than
following gastric bypass; this allows for larger meals.
Reduced risk of developing ulcers
The intestinal bypass part of the surgery is partially reversible for those having
malabsorptive complications.
Possibly greater long-term weight loss and less chance of regaining weight
More rapid weight loss, compared with gastric banding procedures
Lower risk of dumping syndrome, which occurs when the undigested stomach
contents are "dumped" into the small intestine too quickly. It is marked by
abdominal cramps and nausea.
Regression of obesity-related illnesses
Long Term Results:
Based on patient averages, one can expect to lose about 80 to 100 % of the
excess body weight. Lifelong nutritional follow-up is mandatory.
Relevant Publications by Dr. Frantzides on the procedure
Minimally Invasive Biliopancreatic Diversion with Duodenal Switch;
In Atlas of Minimally Invasive Surgery Frantzides CT, Carlson (eds.) Elsevier
2008